| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,138 |
944 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
263 |
240 |
$203K |
| D4220 |
|
267 |
252 |
$166K |
| D2140 |
|
841 |
717 |
$143K |
| D1120 |
Prophylaxis - child |
1,297 |
1,292 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
890 |
$66K |
| D2160 |
|
413 |
328 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
181 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,287 |
1,281 |
$54K |
| D4341 |
|
88 |
86 |
$52K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
74 |
68 |
$29K |
| D0274 |
Bitewings - four radiographic images |
721 |
720 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,573 |
1,554 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,368 |
1,358 |
$16K |
| D1203 |
|
755 |
753 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
442 |
$14K |
| D3120 |
|
199 |
163 |
$14K |
| D2330 |
|
81 |
77 |
$13K |
| D0272 |
Bitewings - two radiographic images |
517 |
515 |
$13K |
| D2161 |
|
76 |
63 |
$12K |
| D1110 |
Prophylaxis - adult |
149 |
149 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
24 |
$6K |
| D2335 |
|
13 |
12 |
$6K |
| D2950 |
|
17 |
17 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$804.00 |