| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,565 |
3,326 |
$508K |
| D2140 |
|
7,303 |
3,051 |
$454K |
| D0120 |
Periodic oral evaluation - established patient |
15,052 |
14,745 |
$390K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,556 |
2,259 |
$340K |
| D1110 |
Prophylaxis - adult |
6,977 |
6,869 |
$326K |
| D1120 |
Prophylaxis - child |
9,131 |
8,921 |
$320K |
| D0272 |
Bitewings - two radiographic images |
13,128 |
12,890 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,702 |
1,982 |
$284K |
| D0240 |
|
11,169 |
10,913 |
$266K |
| D0220 |
Intraoral - periapical first radiographic image |
15,158 |
14,692 |
$258K |
| D1206 |
Topical application of fluoride varnish |
9,684 |
9,561 |
$189K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,899 |
6,501 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
1,796 |
1,769 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,598 |
5,442 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,213 |
4,191 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,247 |
507 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,499 |
2,383 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
390 |
286 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
435 |
185 |
$52K |
| D0602 |
|
9,613 |
9,503 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
914 |
910 |
$30K |
| D2160 |
|
329 |
226 |
$29K |
| D0330 |
Panoramic radiographic image |
1,075 |
1,053 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
272 |
201 |
$23K |
| D2332 |
|
174 |
103 |
$19K |
| D7111 |
|
209 |
134 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
73 |
$9K |
| D0603 |
|
1,454 |
1,424 |
$7K |
| D1351 |
Sealant - per tooth |
133 |
53 |
$4K |
| D0601 |
|
469 |
459 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$148.20 |