| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,632 |
3,074 |
$482K |
| D1120 |
Prophylaxis - child |
8,051 |
7,557 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,787 |
10,082 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,822 |
1,409 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
10,195 |
9,545 |
$187K |
| D2140 |
|
3,951 |
1,882 |
$187K |
| D1110 |
Prophylaxis - adult |
3,739 |
3,495 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,680 |
810 |
$116K |
| D1351 |
Sealant - per tooth |
4,596 |
1,144 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,643 |
719 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
723 |
338 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,227 |
3,965 |
$84K |
| D9920 |
|
1,515 |
1,323 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,242 |
1,976 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,706 |
1,590 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,329 |
1,259 |
$41K |
| D0240 |
|
2,744 |
1,401 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,019 |
747 |
$24K |
| D2160 |
|
281 |
195 |
$21K |
| D0330 |
Panoramic radiographic image |
337 |
328 |
$17K |
| D7111 |
|
260 |
137 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
303 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
55 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
12 |
$149.00 |