| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,857 |
5,415 |
$947K |
| D2160 |
|
4,315 |
2,722 |
$478K |
| D0120 |
Periodic oral evaluation - established patient |
17,642 |
17,325 |
$458K |
| D1110 |
Prophylaxis - adult |
8,260 |
8,107 |
$317K |
| D1120 |
Prophylaxis - child |
10,182 |
10,000 |
$278K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,674 |
15,390 |
$263K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,987 |
1,840 |
$255K |
| D2161 |
|
1,726 |
1,254 |
$211K |
| D2140 |
|
2,084 |
1,390 |
$157K |
| D1351 |
Sealant - per tooth |
5,409 |
2,147 |
$155K |
| D0330 |
Panoramic radiographic image |
2,631 |
2,569 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,891 |
3,818 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
791 |
544 |
$116K |
| D0272 |
Bitewings - two radiographic images |
5,907 |
5,796 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
6,632 |
6,368 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,116 |
2,041 |
$89K |
| D2335 |
|
519 |
271 |
$64K |
| D4355 |
|
921 |
885 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
845 |
807 |
$60K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
731 |
432 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
679 |
437 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
484 |
272 |
$54K |
| D7111 |
|
838 |
574 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,362 |
2,610 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
909 |
873 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
614 |
558 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,655 |
1,605 |
$26K |
| D0170 |
|
766 |
713 |
$22K |
| D2332 |
|
190 |
122 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
514 |
446 |
$16K |
| D2330 |
|
136 |
88 |
$9K |
| D2950 |
|
76 |
43 |
$7K |
| D1515 |
|
15 |
12 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
19 |
$3K |
| D4342 |
|
27 |
13 |
$2K |