| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,665 |
496 |
$357K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,424 |
558 |
$162K |
| D9420 |
|
586 |
566 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
730 |
274 |
$83K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
674 |
297 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
998 |
976 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
251 |
150 |
$38K |
| D2330 |
|
154 |
86 |
$18K |
| D0240 |
|
614 |
515 |
$17K |
| D0272 |
Bitewings - two radiographic images |
195 |
193 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
122 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
20 |
$2K |