| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
4,323 |
4,022 |
$5.03M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
130 |
130 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
25 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
53 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$20K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
40 |
$0.00 |
| D4341 |
|
12 |
12 |
$0.00 |