| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,644 |
303 |
$209K |
| D9420 |
|
707 |
669 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
900 |
209 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
183 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
672 |
$22K |
| D1206 |
Topical application of fluoride varnish |
674 |
639 |
$21K |
| D1120 |
Prophylaxis - child |
674 |
640 |
$21K |
| D0272 |
Bitewings - two radiographic images |
472 |
436 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
38 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
613 |
582 |
$9K |
| D1351 |
Sealant - per tooth |
50 |
14 |
$1K |