| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,874 |
1,838 |
$3.14M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,891 |
1,533 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,998 |
921 |
$937K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,348 |
681 |
$529K |
| D2330 |
|
1,253 |
676 |
$504K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,255 |
1,358 |
$383K |
| D2335 |
|
397 |
169 |
$267K |
| D2332 |
|
623 |
361 |
$250K |
| D2932 |
|
465 |
194 |
$164K |
| D2390 |
|
155 |
96 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
71 |
$50K |
| D2331 |
|
104 |
54 |
$20K |
| D1120 |
Prophylaxis - child |
1,038 |
891 |
$20K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
129 |
65 |
$6K |
| D1351 |
Sealant - per tooth |
742 |
320 |
$509.85 |
| D3120 |
|
17 |
12 |
$477.36 |
| D1208 |
Topical application of fluoride, excluding varnish |
162 |
146 |
$22.67 |
| D1510 |
|
58 |
41 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
117 |
102 |
$0.00 |