| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,131 |
1,126 |
$687K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
918 |
896 |
$556K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,200 |
1,166 |
$124K |
| D9420 |
|
1,325 |
1,292 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
549 |
530 |
$14K |
| D2934 |
|
220 |
217 |
$14K |
| 64718 |
|
13 |
12 |
$9K |
| D3230 |
|
233 |
230 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
322 |
$7K |
| D2330 |
|
25 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
439 |
423 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
361 |
$615.14 |
| D0230 |
Intraoral - periapical each additional radiographic image |
300 |
299 |
$480.95 |
| D3240 |
|
41 |
41 |
$0.00 |
| D1351 |
Sealant - per tooth |
37 |
37 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
56 |
$0.00 |
| D2332 |
|
25 |
25 |
$0.00 |