| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
8,400 |
1,391 |
$672K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,236 |
866 |
$150K |
| D1120 |
Prophylaxis - child |
2,876 |
2,871 |
$146K |
| D2140 |
|
2,367 |
784 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,723 |
1,721 |
$115K |
| D1351 |
Sealant - per tooth |
3,005 |
866 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,579 |
443 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,392 |
596 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,940 |
1,911 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,179 |
1,177 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
603 |
212 |
$72K |
| D1310 |
|
1,431 |
1,429 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,392 |
2,390 |
$53K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
477 |
168 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,013 |
2,142 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
830 |
828 |
$40K |
| D0350 |
|
3,056 |
1,102 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
470 |
470 |
$31K |
| D1110 |
Prophylaxis - adult |
352 |
352 |
$30K |
| D0603 |
|
1,373 |
1,371 |
$20K |
| D2332 |
|
232 |
58 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,419 |
1,413 |
$17K |
| D2160 |
|
207 |
121 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
81 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
831 |
$12K |
| D1320 |
|
975 |
975 |
$12K |
| D0274 |
Bitewings - four radiographic images |
286 |
286 |
$6K |
| D2331 |
|
78 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
454 |
454 |
$5K |
| D9430 |
|
12 |
12 |
$384.00 |