| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
3,361 |
3,354 |
$2.06M |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,202 |
3,201 |
$1.98M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,073 |
4,056 |
$620K |
| D9420 |
|
1,482 |
1,482 |
$135K |
| D2934 |
|
341 |
341 |
$114K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
650 |
650 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
596 |
594 |
$76K |
| D2332 |
|
575 |
316 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
362 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
424 |
424 |
$49K |
| D2330 |
|
282 |
168 |
$18K |
| D1351 |
Sealant - per tooth |
312 |
312 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
927 |
$12K |
| D0272 |
Bitewings - two radiographic images |
898 |
896 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
973 |
971 |
$9K |