| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2940 |
|
1,231 |
834 |
$391K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,276 |
1,090 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,015 |
2,009 |
$148K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
347 |
298 |
$136K |
| D1120 |
Prophylaxis - child |
2,140 |
2,130 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
454 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
371 |
348 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,950 |
1,924 |
$80K |
| D4220 |
|
183 |
153 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
811 |
808 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
832 |
827 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,528 |
2,495 |
$37K |
| D2160 |
|
238 |
203 |
$36K |
| D2140 |
|
295 |
256 |
$34K |
| D2950 |
|
168 |
154 |
$31K |
| D1203 |
|
1,546 |
1,540 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
725 |
$30K |
| D1351 |
Sealant - per tooth |
280 |
245 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
590 |
545 |
$20K |
| D2335 |
|
30 |
25 |
$9K |
| D1110 |
Prophylaxis - adult |
157 |
156 |
$7K |
| D0274 |
Bitewings - four radiographic images |
212 |
212 |
$7K |
| D1510 |
|
13 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$750.00 |
| D3120 |
|
13 |
12 |
$602.00 |