| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,853 |
2,311 |
$275K |
| D1120 |
Prophylaxis - child |
7,762 |
7,707 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,795 |
6,727 |
$226K |
| D2140 |
|
3,993 |
2,369 |
$216K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,452 |
695 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,649 |
9,559 |
$168K |
| D7240 |
Removal of impacted tooth - completely bony |
885 |
267 |
$165K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,995 |
803 |
$158K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,299 |
1,197 |
$150K |
| D0274 |
Bitewings - four radiographic images |
5,250 |
5,166 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
12,626 |
12,211 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,110 |
4,923 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,020 |
11,412 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,045 |
2,909 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,346 |
3,317 |
$70K |
| D1110 |
Prophylaxis - adult |
1,743 |
1,718 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,097 |
3,073 |
$62K |
| D2160 |
|
348 |
270 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
273 |
142 |
$30K |
| D0330 |
Panoramic radiographic image |
715 |
713 |
$25K |
| D7971 |
|
415 |
248 |
$23K |
| D1351 |
Sealant - per tooth |
610 |
303 |
$14K |
| D9995 |
|
106 |
102 |
$3K |
| D9248 |
|
126 |
118 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
278 |
211 |
$2K |
| D4346 |
|
12 |
12 |
$1K |
| D2330 |
|
17 |
13 |
$1K |
| D0340 |
|
26 |
26 |
$1K |