| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,746 |
1,630 |
$180K |
| D2160 |
|
1,951 |
1,291 |
$151K |
| D1110 |
Prophylaxis - adult |
1,804 |
1,757 |
$139K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,142 |
727 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
2,540 |
2,488 |
$102K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
198 |
149 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,484 |
1,438 |
$85K |
| D2954 |
|
792 |
644 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,305 |
667 |
$73K |
| D1120 |
Prophylaxis - child |
1,845 |
1,799 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,056 |
1,021 |
$46K |
| D3221 |
|
492 |
418 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,538 |
2,490 |
$29K |
| D3320 |
|
76 |
70 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,188 |
2,466 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,881 |
1,840 |
$22K |
| D3310 |
|
65 |
49 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
40 |
$19K |
| D1351 |
Sealant - per tooth |
907 |
225 |
$18K |
| D1206 |
Topical application of fluoride varnish |
976 |
974 |
$17K |
| D2161 |
|
207 |
185 |
$17K |
| D2140 |
|
320 |
226 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,946 |
1,902 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
236 |
143 |
$16K |
| D2931 |
|
87 |
78 |
$11K |
| D2330 |
|
126 |
70 |
$9K |
| D0350 |
|
913 |
590 |
$9K |
| D4341 |
|
101 |
39 |
$6K |
| D4910 |
|
41 |
40 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
24 |
$3K |
| D9430 |
|
75 |
75 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
25 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$325.00 |