| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71,167 |
20,931 |
$12.23M |
| D7140 |
Extraction, erupted tooth or exposed root |
45,056 |
17,296 |
$7.57M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23,387 |
19,542 |
$2.99M |
| D9420 |
|
29,679 |
25,723 |
$1.56M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,150 |
5,553 |
$1.30M |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
24,375 |
20,233 |
$1.21M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,326 |
6,574 |
$846K |
| D2934 |
|
11,236 |
5,523 |
$588K |
| D7111 |
|
4,460 |
2,364 |
$556K |
| D2330 |
|
9,186 |
5,555 |
$420K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
674 |
616 |
$330K |
| D2332 |
|
3,430 |
2,201 |
$143K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,558 |
8,765 |
$120K |
| D2932 |
|
1,299 |
616 |
$111K |
| D2390 |
|
1,224 |
662 |
$102K |
| D2331 |
|
2,324 |
1,645 |
$99K |
| D3120 |
|
10,914 |
5,750 |
$88K |
| D2931 |
|
427 |
248 |
$85K |
| 99499 |
|
948 |
94 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
420 |
321 |
$60K |
| D4355 |
|
224 |
205 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
22,852 |
19,520 |
$50K |
| D2335 |
|
91 |
66 |
$38K |
| D0350 |
|
22,430 |
19,169 |
$31K |
| D0603 |
|
22,239 |
18,923 |
$24K |
| D1351 |
Sealant - per tooth |
31,731 |
12,915 |
$17K |
| D0272 |
Bitewings - two radiographic images |
59 |
56 |
$11K |
| D1330 |
|
22,981 |
19,620 |
$9K |
| D1510 |
|
1,465 |
1,043 |
$4K |
| D2950 |
|
172 |
144 |
$903.79 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,756 |
1,403 |
$292.95 |
| D0220 |
Intraoral - periapical first radiographic image |
1,585 |
1,417 |
$99.54 |
| D9971 |
|
1,071 |
704 |
$0.00 |
| D2954 |
|
18 |
12 |
$0.00 |