| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,234 |
8,230 |
$1.82M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,433 |
6,632 |
$1.20M |
| D1120 |
Prophylaxis - child |
33,395 |
32,833 |
$1.11M |
| D0120 |
Periodic oral evaluation - established patient |
45,391 |
44,682 |
$1.06M |
| D1206 |
Topical application of fluoride varnish |
54,852 |
54,031 |
$1.04M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,298 |
3,390 |
$895K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,306 |
30,615 |
$756K |
| D1110 |
Prophylaxis - adult |
16,513 |
16,302 |
$755K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,681 |
2,784 |
$642K |
| D2140 |
|
6,862 |
4,079 |
$614K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,248 |
14,701 |
$479K |
| D0220 |
Intraoral - periapical first radiographic image |
35,314 |
34,729 |
$434K |
| D0272 |
Bitewings - two radiographic images |
20,609 |
20,266 |
$421K |
| D1351 |
Sealant - per tooth |
11,356 |
3,915 |
$392K |
| D2160 |
|
2,182 |
1,418 |
$289K |
| D9420 |
|
2,358 |
2,319 |
$265K |
| D0274 |
Bitewings - four radiographic images |
8,297 |
8,196 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,126 |
6,038 |
$239K |
| D2934 |
|
1,102 |
359 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,465 |
1,050 |
$181K |
| D0330 |
Panoramic radiographic image |
2,570 |
2,520 |
$133K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,996 |
3,957 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,164 |
766 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
2,096 |
2,067 |
$71K |
| D2330 |
|
262 |
143 |
$25K |
| D3120 |
|
469 |
336 |
$18K |
| D2331 |
|
111 |
67 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
53 |
$8K |
| D7960 |
|
26 |
26 |
$6K |
| D1510 |
|
15 |
12 |
$2K |
| D1353 |
|
53 |
25 |
$2K |
| D9310 |
|
24 |
24 |
$984.12 |