| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,243 |
1,351 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,402 |
4,393 |
$158K |
| D1120 |
Prophylaxis - child |
4,723 |
4,715 |
$155K |
| D0274 |
Bitewings - four radiographic images |
4,017 |
4,013 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,459 |
5,449 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,190 |
8,003 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,605 |
7,103 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
941 |
510 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,125 |
1,944 |
$60K |
| D1110 |
Prophylaxis - adult |
1,285 |
1,284 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,957 |
1,956 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,275 |
1,243 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,783 |
1,780 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
256 |
162 |
$30K |
| D2140 |
|
377 |
268 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
310 |
227 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
253 |
152 |
$20K |
| D1351 |
Sealant - per tooth |
739 |
295 |
$18K |
| D0330 |
Panoramic radiographic image |
660 |
660 |
$16K |
| D2332 |
|
77 |
56 |
$9K |
| D4346 |
|
37 |
37 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
53 |
$4K |
| D2160 |
|
33 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
44 |
$649.39 |