| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46,762 |
15,657 |
$8.25M |
| D7140 |
Extraction, erupted tooth or exposed root |
34,935 |
13,551 |
$6.10M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,242 |
17,707 |
$2.68M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,990 |
5,120 |
$838K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
14,765 |
11,274 |
$646K |
| D2934 |
|
14,366 |
6,427 |
$604K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,033 |
3,388 |
$598K |
| D9420 |
|
21,117 |
17,856 |
$488K |
| D7111 |
|
2,048 |
1,159 |
$369K |
| D2330 |
|
5,545 |
3,862 |
$286K |
| D0603 |
|
20,545 |
17,117 |
$171K |
| D0350 |
|
11,895 |
9,999 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
632 |
458 |
$75K |
| D1330 |
|
20,986 |
17,658 |
$74K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
236 |
199 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,110 |
4,473 |
$61K |
| D2332 |
|
1,747 |
1,124 |
$59K |
| 99499 |
|
794 |
82 |
$52K |
| D3120 |
|
4,236 |
2,250 |
$41K |
| D2331 |
|
1,058 |
709 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
21,165 |
17,592 |
$25K |
| D4355 |
|
123 |
123 |
$20K |
| D2931 |
|
146 |
80 |
$19K |
| D1351 |
Sealant - per tooth |
20,330 |
9,577 |
$9K |
| D9971 |
|
1,894 |
1,480 |
$144.57 |
| D1999 |
|
17 |
12 |
$0.00 |