| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,179 |
2,931 |
$510K |
| D1110 |
Prophylaxis - adult |
9,966 |
9,791 |
$482K |
| D0120 |
Periodic oral evaluation - established patient |
15,231 |
15,021 |
$422K |
| D1120 |
Prophylaxis - child |
8,572 |
8,465 |
$305K |
| D2160 |
|
2,512 |
1,703 |
$304K |
| D1351 |
Sealant - per tooth |
7,853 |
1,909 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,618 |
10,472 |
$217K |
| D0272 |
Bitewings - two radiographic images |
9,189 |
8,993 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
1,906 |
1,903 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,500 |
2,425 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
8,371 |
7,623 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
713 |
449 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,425 |
5,372 |
$70K |
| D1206 |
Topical application of fluoride varnish |
2,561 |
2,528 |
$64K |
| D2140 |
|
814 |
603 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
542 |
374 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
270 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
473 |
463 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,624 |
1,588 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
40 |
$7K |
| D0330 |
Panoramic radiographic image |
139 |
131 |
$7K |
| D7111 |
|
58 |
37 |
$3K |
| D2335 |
|
19 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$1K |
| D1999 |
|
55 |
52 |
$155.00 |