| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,989 |
2,445 |
$1.96M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,894 |
2,380 |
$1.55M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,970 |
885 |
$546K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,513 |
656 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,862 |
835 |
$226K |
| D2934 |
|
1,314 |
459 |
$101K |
| D2330 |
|
906 |
496 |
$95K |
| D7240 |
Removal of impacted tooth - completely bony |
59 |
29 |
$22K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
417 |
372 |
$13K |
| D7111 |
|
93 |
43 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
198 |
$7K |
| D2331 |
|
50 |
25 |
$7K |
| D2332 |
|
47 |
26 |
$1K |
| D9420 |
|
246 |
200 |
$784.00 |
| D1351 |
Sealant - per tooth |
295 |
99 |
$764.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
808 |
201 |
$510.00 |
| D0240 |
|
235 |
193 |
$330.00 |
| D0272 |
Bitewings - two radiographic images |
222 |
181 |
$302.00 |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
196 |
$181.00 |
| D1330 |
|
239 |
194 |
$50.00 |
| D0603 |
|
130 |
102 |
$0.01 |
| D3120 |
|
64 |
32 |
$0.00 |