| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,166 |
4,082 |
$3.18M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,843 |
3,958 |
$699K |
| D9420 |
|
4,987 |
4,832 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
6,181 |
5,840 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
4,940 |
4,785 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,891 |
4,737 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,640 |
841 |
$23K |
| D1351 |
Sealant - per tooth |
9,475 |
2,564 |
$19K |
| D2330 |
|
1,904 |
1,001 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,694 |
979 |
$11K |
| D7111 |
|
1,032 |
420 |
$11K |
| D0350 |
|
4,812 |
4,658 |
$11K |
| D2934 |
|
244 |
99 |
$7K |
| D0603 |
|
8,314 |
7,418 |
$4K |
| D1330 |
|
4,754 |
4,600 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
301 |
174 |
$2K |
| D0272 |
Bitewings - two radiographic images |
242 |
225 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
254 |
163 |
$775.84 |
| D0220 |
Intraoral - periapical first radiographic image |
236 |
225 |
$720.76 |
| D9971 |
|
21 |
12 |
$0.00 |
| D2332 |
|
85 |
57 |
$0.00 |
| D3120 |
|
316 |
188 |
$0.00 |
| D2331 |
|
22 |
14 |
$0.00 |