| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,511 |
4,378 |
$418K |
| D0120 |
Periodic oral evaluation - established patient |
15,976 |
15,906 |
$391K |
| D1120 |
Prophylaxis - child |
11,156 |
11,109 |
$381K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,956 |
16,894 |
$357K |
| D1110 |
Prophylaxis - adult |
6,270 |
6,252 |
$275K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,442 |
7,661 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,523 |
2,273 |
$229K |
| D0210 |
Intraoral - complete series of radiographic images |
3,101 |
3,091 |
$192K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,378 |
6,750 |
$178K |
| D2160 |
|
1,551 |
1,406 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
9,768 |
9,554 |
$122K |
| D2140 |
|
1,804 |
1,491 |
$113K |
| D0272 |
Bitewings - two radiographic images |
5,789 |
5,758 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,145 |
3,136 |
$85K |
| D1351 |
Sealant - per tooth |
2,391 |
661 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,472 |
2,470 |
$72K |
| D1206 |
Topical application of fluoride varnish |
1,551 |
1,548 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
244 |
219 |
$28K |
| D9110 |
|
117 |
116 |
$6K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$994.44 |
| D1999 |
|
24 |
24 |
$0.00 |