| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24,916 |
16,922 |
$2.91M |
| D2140 |
|
23,655 |
15,286 |
$2.19M |
| D0120 |
Periodic oral evaluation - established patient |
72,500 |
72,427 |
$1.69M |
| D1110 |
Prophylaxis - adult |
33,739 |
33,702 |
$1.48M |
| D1206 |
Topical application of fluoride varnish |
76,992 |
76,913 |
$1.39M |
| D1120 |
Prophylaxis - child |
39,678 |
39,638 |
$1.27M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,768 |
6,640 |
$1.08M |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,108 |
49,008 |
$938K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,217 |
3,935 |
$788K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,356 |
4,275 |
$771K |
| D0274 |
Bitewings - four radiographic images |
24,454 |
24,411 |
$735K |
| D0220 |
Intraoral - periapical first radiographic image |
53,977 |
53,828 |
$682K |
| D2160 |
|
4,132 |
3,288 |
$583K |
| D0272 |
Bitewings - two radiographic images |
18,973 |
18,944 |
$397K |
| D0330 |
Panoramic radiographic image |
4,197 |
4,192 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
7,869 |
7,832 |
$199K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,266 |
1,360 |
$198K |
| D3120 |
|
4,853 |
3,242 |
$181K |
| D1351 |
Sealant - per tooth |
4,636 |
1,346 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,473 |
3,470 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
3,968 |
3,945 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
743 |
516 |
$99K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,399 |
2,397 |
$76K |
| D2330 |
|
286 |
204 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
814 |
788 |
$25K |
| D2750 |
|
19 |
14 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |