| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,049 |
4,748 |
$836K |
| D0120 |
Periodic oral evaluation - established patient |
28,372 |
28,197 |
$670K |
| D1110 |
Prophylaxis - adult |
14,240 |
14,139 |
$640K |
| D1120 |
Prophylaxis - child |
15,723 |
15,621 |
$525K |
| D1206 |
Topical application of fluoride varnish |
21,230 |
20,988 |
$405K |
| D2140 |
|
4,001 |
2,771 |
$401K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,664 |
2,302 |
$392K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,336 |
2,168 |
$337K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,382 |
1,704 |
$330K |
| D0274 |
Bitewings - four radiographic images |
9,062 |
8,966 |
$268K |
| D0220 |
Intraoral - periapical first radiographic image |
19,657 |
19,376 |
$247K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,805 |
1,214 |
$239K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,662 |
17,456 |
$230K |
| D0272 |
Bitewings - two radiographic images |
7,702 |
7,628 |
$161K |
| D2160 |
|
1,054 |
857 |
$158K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,519 |
4,070 |
$143K |
| D1351 |
Sealant - per tooth |
3,995 |
1,440 |
$136K |
| D3120 |
|
3,439 |
1,976 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,587 |
2,553 |
$103K |
| D0330 |
Panoramic radiographic image |
1,926 |
1,926 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
1,578 |
1,550 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,352 |
4,347 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
364 |
272 |
$32K |
| D2330 |
|
50 |
26 |
$5K |
| D1354 |
|
24 |
12 |
$190.60 |