| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,394 |
4,481 |
$880K |
| D2140 |
|
5,324 |
3,345 |
$502K |
| D0120 |
Periodic oral evaluation - established patient |
17,638 |
17,588 |
$411K |
| D1110 |
Prophylaxis - adult |
8,941 |
8,919 |
$395K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,434 |
1,989 |
$345K |
| D1120 |
Prophylaxis - child |
10,669 |
10,635 |
$343K |
| D1206 |
Topical application of fluoride varnish |
18,125 |
18,060 |
$330K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,202 |
762 |
$291K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,443 |
1,388 |
$256K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,329 |
13,272 |
$252K |
| D0274 |
Bitewings - four radiographic images |
6,700 |
6,684 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
15,128 |
14,998 |
$190K |
| D2160 |
|
1,036 |
755 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,918 |
2,906 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
852 |
570 |
$113K |
| D0272 |
Bitewings - two radiographic images |
4,899 |
4,871 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
2,487 |
2,472 |
$88K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
974 |
305 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
1,777 |
1,753 |
$60K |
| D3120 |
|
1,453 |
951 |
$54K |
| D0330 |
Panoramic radiographic image |
1,010 |
1,010 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,381 |
1,256 |
$43K |
| D2750 |
|
17 |
14 |
$14K |
| D9420 |
|
112 |
112 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
409 |
409 |
$13K |
| D2330 |
|
103 |
77 |
$10K |
| D2331 |
|
56 |
43 |
$7K |
| D1351 |
Sealant - per tooth |
171 |
60 |
$6K |