| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,870 |
3,696 |
$527K |
| D0120 |
Periodic oral evaluation - established patient |
7,453 |
7,451 |
$319K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,395 |
4,392 |
$266K |
| D2140 |
|
4,681 |
2,368 |
$255K |
| D1120 |
Prophylaxis - child |
8,133 |
8,123 |
$242K |
| D2160 |
|
2,668 |
1,574 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,804 |
9,323 |
$200K |
| D1110 |
Prophylaxis - adult |
1,895 |
1,894 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
2,926 |
2,922 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,943 |
1,109 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,639 |
2,574 |
$104K |
| D0350 |
|
8,092 |
3,943 |
$94K |
| D9993 |
|
1,474 |
1,472 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,650 |
3,649 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,963 |
7,957 |
$74K |
| D2330 |
|
932 |
399 |
$71K |
| D1310 |
|
1,501 |
1,499 |
$67K |
| D1351 |
Sealant - per tooth |
2,817 |
1,068 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,869 |
3,864 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,266 |
2,263 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,578 |
2,553 |
$30K |
| D9430 |
|
595 |
592 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
157 |
91 |
$18K |
| D0603 |
|
1,028 |
1,026 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
43 |
24 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
94 |
$4K |
| D0602 |
|
268 |
268 |
$4K |
| D4910 |
|
44 |
44 |
$3K |
| D4341 |
|
41 |
13 |
$3K |
| D4342 |
|
37 |
14 |
$2K |