| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,749 |
1,840 |
$1.36M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,083 |
1,150 |
$243K |
| D2934 |
|
1,000 |
341 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,978 |
873 |
$118K |
| D1351 |
Sealant - per tooth |
3,049 |
931 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
773 |
378 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,106 |
2,072 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
963 |
515 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,100 |
2,010 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,049 |
2,017 |
$46K |
| D2330 |
|
368 |
193 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,026 |
1,994 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
213 |
211 |
$15K |
| D2331 |
|
20 |
13 |
$2K |
| D0160 |
|
80 |
77 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
35 |
$619.74 |
| D0603 |
|
2,439 |
2,385 |
$0.00 |