| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2940 |
|
2,076 |
2,019 |
$1.18M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,808 |
2,808 |
$207K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,437 |
1,320 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
574 |
532 |
$203K |
| D1120 |
Prophylaxis - child |
3,263 |
3,263 |
$189K |
| D4220 |
|
450 |
385 |
$187K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,739 |
2,733 |
$99K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
424 |
393 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,179 |
2,013 |
$86K |
| D3120 |
|
869 |
796 |
$84K |
| D2160 |
|
533 |
506 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
222 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,038 |
2,038 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,358 |
3,329 |
$49K |
| D1110 |
Prophylaxis - adult |
921 |
921 |
$45K |
| D1203 |
|
2,139 |
2,139 |
$41K |
| D2140 |
|
310 |
295 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
407 |
407 |
$30K |
| D0274 |
Bitewings - four radiographic images |
735 |
735 |
$25K |
| D1351 |
Sealant - per tooth |
179 |
176 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
338 |
334 |
$22K |
| D4355 |
|
108 |
108 |
$17K |
| D2161 |
|
69 |
64 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
38 |
$8K |
| D2335 |
|
17 |
14 |
$6K |
| D2330 |
|
13 |
13 |
$2K |