| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,766 |
1,679 |
$158K |
| D1120 |
Prophylaxis - child |
6,691 |
5,351 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
6,558 |
5,406 |
$91K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
827 |
221 |
$80K |
| D2140 |
|
2,438 |
1,252 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,774 |
4,291 |
$62K |
| D0330 |
Panoramic radiographic image |
1,619 |
1,339 |
$60K |
| D1351 |
Sealant - per tooth |
3,628 |
591 |
$45K |
| D1110 |
Prophylaxis - adult |
1,464 |
1,200 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,114 |
2,029 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
595 |
345 |
$28K |
| D0272 |
Bitewings - two radiographic images |
3,759 |
2,914 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,917 |
1,461 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,222 |
867 |
$22K |
| D2160 |
|
313 |
199 |
$17K |
| D0240 |
|
1,048 |
368 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,527 |
1,143 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
240 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
510 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
13 |
$2K |