| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
721 |
607 |
$52K |
| D1120 |
Prophylaxis - child |
1,096 |
1,044 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
590 |
489 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,371 |
1,246 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,206 |
1,144 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,028 |
974 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
199 |
169 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
198 |
170 |
$12K |
| D2140 |
|
244 |
208 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
347 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
928 |
830 |
$5K |
| D2160 |
|
60 |
56 |
$4K |
| D9110 |
|
73 |
72 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
414 |
380 |
$2K |
| D0272 |
Bitewings - two radiographic images |
161 |
147 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$1K |