| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,913 |
1,722 |
$3.71M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,474 |
1,489 |
$2.60M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,561 |
1,070 |
$1.61M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,398 |
595 |
$466K |
| D9420 |
|
2,825 |
2,095 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
51 |
$30K |
| D1351 |
Sealant - per tooth |
581 |
286 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
229 |
171 |
$9K |
| D1510 |
|
49 |
40 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
68 |
$32.41 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
37 |
$0.00 |
| D1120 |
Prophylaxis - child |
65 |
58 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
24 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
46 |
43 |
$0.00 |