| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,822 |
829 |
$119K |
| D1120 |
Prophylaxis - child |
3,718 |
3,649 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,048 |
3,006 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,938 |
3,574 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,053 |
579 |
$60K |
| D2140 |
|
939 |
552 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
961 |
941 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,197 |
4,127 |
$42K |
| D1351 |
Sealant - per tooth |
1,687 |
473 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
279 |
136 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
283 |
134 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
606 |
596 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,200 |
1,185 |
$23K |
| D1110 |
Prophylaxis - adult |
363 |
360 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,450 |
1,431 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
64 |
22 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
389 |
383 |
$15K |
| D4341 |
|
183 |
49 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,023 |
1,002 |
$11K |
| D0350 |
|
943 |
593 |
$8K |
| D9430 |
|
252 |
243 |
$7K |
| D0330 |
Panoramic radiographic image |
295 |
294 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
233 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
171 |
164 |
$7K |
| D2160 |
|
76 |
61 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
27 |
$5K |
| D2330 |
|
70 |
39 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D2332 |
|
17 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$198.00 |
| D1310 |
|
53 |
53 |
$0.00 |