| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,798 |
5,028 |
$858K |
| D1120 |
Prophylaxis - child |
18,105 |
17,989 |
$838K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,370 |
1,938 |
$764K |
| D0120 |
Periodic oral evaluation - established patient |
9,915 |
9,831 |
$712K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,162 |
2,076 |
$711K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,136 |
7,104 |
$481K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
965 |
684 |
$459K |
| D1310 |
|
9,935 |
9,874 |
$454K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,989 |
3,435 |
$400K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,256 |
19,918 |
$389K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,580 |
19,450 |
$369K |
| D2140 |
|
6,186 |
2,966 |
$337K |
| D1351 |
Sealant - per tooth |
10,010 |
3,413 |
$336K |
| D2160 |
|
3,481 |
1,649 |
$277K |
| D4341 |
|
3,231 |
861 |
$226K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,075 |
5,044 |
$203K |
| D9993 |
|
2,894 |
2,894 |
$180K |
| D4910 |
|
2,113 |
2,090 |
$162K |
| D1110 |
Prophylaxis - adult |
1,725 |
1,725 |
$152K |
| D9430 |
|
4,634 |
4,443 |
$148K |
| D0603 |
|
9,925 |
9,864 |
$148K |
| D0220 |
Intraoral - periapical first radiographic image |
11,738 |
11,594 |
$141K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,813 |
1,801 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
2,297 |
2,274 |
$110K |
| D0350 |
|
4,602 |
4,309 |
$100K |
| D0330 |
Panoramic radiographic image |
2,693 |
2,693 |
$81K |
| D3221 |
|
1,137 |
778 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
601 |
408 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,890 |
2,861 |
$61K |
| D3320 |
|
165 |
137 |
$60K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
132 |
118 |
$60K |
| D2330 |
|
745 |
406 |
$58K |
| D2954 |
|
470 |
349 |
$49K |
| D1320 |
|
2,693 |
2,693 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,167 |
3,145 |
$38K |
| D4342 |
|
834 |
248 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,583 |
1,583 |
$28K |
| D2331 |
|
219 |
145 |
$18K |
| D3310 |
|
55 |
38 |
$17K |
| D1510 |
|
17 |
15 |
$4K |
| D9110 |
|
50 |
34 |
$3K |
| D2161 |
|
27 |
15 |
$2K |
| D0270 |
|
85 |
85 |
$425.00 |