| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,374 |
4,905 |
$773K |
| D1120 |
Prophylaxis - child |
16,311 |
15,772 |
$696K |
| D0120 |
Periodic oral evaluation - established patient |
14,958 |
14,486 |
$486K |
| D2140 |
|
3,391 |
2,541 |
$295K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,127 |
8,966 |
$250K |
| D0330 |
Panoramic radiographic image |
2,836 |
2,731 |
$217K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,911 |
3,395 |
$207K |
| D1206 |
Topical application of fluoride varnish |
7,212 |
6,824 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,504 |
980 |
$162K |
| D0272 |
Bitewings - two radiographic images |
5,380 |
5,221 |
$159K |
| D2160 |
|
1,158 |
1,016 |
$155K |
| D0274 |
Bitewings - four radiographic images |
2,199 |
2,102 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,301 |
1,252 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
428 |
324 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,305 |
3,020 |
$59K |
| D1351 |
Sealant - per tooth |
992 |
392 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
658 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
120 |
85 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
755 |
466 |
$12K |
| D1510 |
|
16 |
12 |
$3K |
| D7111 |
|
17 |
12 |
$1K |