| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,107 |
2,628 |
$542K |
| D1120 |
Prophylaxis - child |
7,775 |
7,728 |
$400K |
| D4341 |
|
4,956 |
1,307 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
4,524 |
4,505 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,452 |
4,443 |
$295K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,052 |
618 |
$245K |
| D2330 |
|
2,883 |
1,064 |
$229K |
| D1110 |
Prophylaxis - adult |
2,572 |
2,569 |
$223K |
| D4910 |
|
2,848 |
2,844 |
$219K |
| D1351 |
Sealant - per tooth |
5,759 |
1,544 |
$217K |
| D1310 |
|
4,564 |
4,528 |
$207K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,801 |
954 |
$207K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,093 |
617 |
$206K |
| D2140 |
|
3,496 |
1,494 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,480 |
954 |
$166K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,790 |
1,380 |
$158K |
| D2160 |
|
1,823 |
1,052 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
2,960 |
2,957 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,252 |
2,863 |
$129K |
| D1206 |
Topical application of fluoride varnish |
4,418 |
4,387 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,004 |
6,124 |
$113K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,627 |
1,613 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,938 |
795 |
$105K |
| D0350 |
|
9,921 |
2,802 |
$101K |
| D9430 |
|
3,153 |
3,012 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,007 |
5,988 |
$84K |
| D0603 |
|
4,547 |
4,512 |
$67K |
| D0330 |
Panoramic radiographic image |
2,186 |
2,165 |
$63K |
| D1320 |
|
3,801 |
3,793 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,527 |
4,293 |
$54K |
| D4342 |
|
1,068 |
328 |
$44K |
| D2335 |
|
253 |
131 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,337 |
1,329 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,576 |
1,549 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
123 |
$15K |
| D3221 |
|
54 |
43 |
$3K |
| D1510 |
|
14 |
13 |
$3K |
| D2331 |
|
30 |
16 |
$2K |