| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,765 |
3,065 |
$350K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,744 |
8,710 |
$303K |
| D1120 |
Prophylaxis - child |
8,988 |
8,962 |
$286K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,954 |
1,012 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,257 |
12,219 |
$224K |
| D0274 |
Bitewings - four radiographic images |
7,509 |
7,488 |
$216K |
| D2140 |
|
3,823 |
2,601 |
$211K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,788 |
6,562 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
15,472 |
15,171 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,995 |
939 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,016 |
14,281 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,209 |
1,211 |
$147K |
| D1110 |
Prophylaxis - adult |
3,198 |
3,186 |
$132K |
| D2160 |
|
1,418 |
1,035 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,360 |
3,212 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,450 |
3,446 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,984 |
2,979 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
344 |
183 |
$38K |
| D0330 |
Panoramic radiographic image |
891 |
888 |
$29K |
| D7971 |
|
486 |
290 |
$27K |
| D1351 |
Sealant - per tooth |
1,089 |
514 |
$27K |
| D9995 |
|
309 |
305 |
$9K |
| D2332 |
|
16 |
15 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$805.85 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$210.10 |