| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,701 |
5,512 |
$730K |
| D1120 |
Prophylaxis - child |
15,078 |
14,426 |
$632K |
| D1206 |
Topical application of fluoride varnish |
16,702 |
16,028 |
$558K |
| D1351 |
Sealant - per tooth |
24,854 |
5,685 |
$495K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,119 |
2,118 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
12,592 |
12,107 |
$270K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,669 |
2,785 |
$213K |
| D0274 |
Bitewings - four radiographic images |
8,568 |
8,276 |
$189K |
| D2140 |
|
4,140 |
2,563 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,754 |
4,578 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
2,350 |
2,256 |
$125K |
| D2160 |
|
1,648 |
1,092 |
$120K |
| D3240 |
|
1,771 |
672 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,256 |
4,502 |
$88K |
| D2933 |
|
971 |
280 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,789 |
3,316 |
$63K |
| D1353 |
|
4,885 |
1,369 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,812 |
4,621 |
$53K |
| D4346 |
|
1,003 |
886 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,938 |
2,783 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
856 |
402 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,226 |
1,181 |
$38K |
| D0350 |
|
13,798 |
12,892 |
$29K |
| D0160 |
|
1,189 |
1,144 |
$28K |
| D2332 |
|
459 |
183 |
$27K |
| D1517 |
|
225 |
212 |
$26K |
| D0330 |
Panoramic radiographic image |
725 |
698 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,654 |
2,438 |
$22K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
225 |
123 |
$21K |
| D9999 |
Unspecified adjunctive procedure, by report |
973 |
973 |
$20K |
| D0999 |
Unspecified diagnostic procedure, by report |
620 |
620 |
$19K |
| D1515 |
|
189 |
112 |
$17K |
| D1510 |
|
173 |
106 |
$12K |
| D1110 |
Prophylaxis - adult |
285 |
276 |
$9K |
| D3230 |
|
160 |
47 |
$8K |
| D9420 |
|
500 |
303 |
$8K |
| D1516 |
|
64 |
61 |
$8K |
| D9212 |
|
1,400 |
865 |
$7K |
| D9222 |
|
152 |
123 |
$6K |
| D1999 |
|
256 |
256 |
$4K |
| D7111 |
|
132 |
74 |
$4K |
| D0190 |
|
167 |
151 |
$2K |
| D4341 |
|
24 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
14 |
$1K |
| D9310 |
|
39 |
34 |
$1K |
| D0603 |
|
1,161 |
1,118 |
$1K |
| D8660 |
|
38 |
36 |
$738.00 |
| D4355 |
|
81 |
62 |
$544.32 |
| D0602 |
|
305 |
298 |
$274.00 |
| D9612 |
|
51 |
33 |
$183.98 |
| D9215 |
|
628 |
372 |
$172.20 |
| D9210 |
|
12 |
12 |
$112.75 |