| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4220 |
|
12,338 |
3,465 |
$2.23M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,317 |
4,788 |
$950K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,892 |
2,636 |
$780K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,872 |
1,820 |
$738K |
| D3120 |
|
15,351 |
4,034 |
$646K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,726 |
7,716 |
$574K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,356 |
2,133 |
$548K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,602 |
11,982 |
$510K |
| D1120 |
Prophylaxis - child |
8,400 |
8,383 |
$498K |
| D2335 |
|
2,474 |
1,144 |
$425K |
| D2160 |
|
3,062 |
2,138 |
$345K |
| D2140 |
|
4,037 |
1,881 |
$284K |
| D2332 |
|
1,850 |
1,097 |
$243K |
| D0140 |
Limited oral evaluation - problem focused |
3,153 |
3,033 |
$208K |
| D0220 |
Intraoral - periapical first radiographic image |
12,919 |
12,722 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
4,100 |
4,098 |
$172K |
| D2950 |
|
1,091 |
866 |
$172K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,622 |
3,955 |
$155K |
| D4341 |
|
267 |
261 |
$149K |
| D2161 |
|
1,127 |
867 |
$148K |
| D1110 |
Prophylaxis - adult |
2,773 |
2,719 |
$141K |
| D1351 |
Sealant - per tooth |
3,360 |
1,434 |
$139K |
| D0274 |
Bitewings - four radiographic images |
3,957 |
3,956 |
$129K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
764 |
500 |
$118K |
| D1203 |
|
5,516 |
5,504 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,201 |
1,199 |
$89K |
| D2330 |
|
673 |
449 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,871 |
1,870 |
$46K |
| D2940 |
|
262 |
240 |
$15K |
| D2331 |
|
148 |
111 |
$15K |
| D9310 |
|
155 |
145 |
$10K |
| D3351 |
|
50 |
44 |
$9K |
| D1510 |
|
51 |
43 |
$9K |
| D4355 |
|
55 |
55 |
$9K |