| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
246 |
245 |
$344K |
| D9310 |
|
264 |
263 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
976 |
213 |
$6K |
| D9420 |
|
233 |
232 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
509 |
153 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$956.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
310 |
243 |
$69.13 |
| D2332 |
|
41 |
25 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
35 |
$0.00 |
| D1510 |
|
21 |
14 |
$0.00 |
| D2933 |
|
45 |
13 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
411 |
159 |
$0.00 |
| D2330 |
|
58 |
34 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
39 |
$0.00 |