| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,292 |
1,932 |
$283K |
| D2140 |
|
4,351 |
2,065 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
4,285 |
4,260 |
$227K |
| D1120 |
Prophylaxis - child |
4,610 |
4,577 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,919 |
1,906 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,571 |
816 |
$87K |
| D9430 |
|
2,623 |
2,313 |
$81K |
| D1351 |
Sealant - per tooth |
2,667 |
1,111 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,376 |
5,335 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,083 |
3,059 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,695 |
5,307 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
992 |
937 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
816 |
811 |
$36K |
| D1110 |
Prophylaxis - adult |
435 |
431 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,943 |
1,782 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
178 |
78 |
$21K |
| D1310 |
|
447 |
447 |
$20K |
| D9993 |
|
356 |
356 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,695 |
1,682 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
69 |
$15K |
| D2160 |
|
179 |
115 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
81 |
39 |
$8K |
| D0350 |
|
620 |
283 |
$4K |
| D4910 |
|
36 |
36 |
$3K |
| D0603 |
|
36 |
36 |
$532.50 |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$468.75 |
| D0602 |
|
14 |
14 |
$210.00 |