| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,438 |
328 |
$208K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
484 |
198 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
598 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
78 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
612 |
598 |
$13K |
| D1120 |
Prophylaxis - child |
611 |
597 |
$8K |
| D1351 |
Sealant - per tooth |
293 |
76 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,995 |
606 |
$7K |
| D0272 |
Bitewings - two radiographic images |
622 |
606 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
621 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
28 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
113 |
109 |
$3K |
| D2330 |
|
26 |
12 |
$1K |