| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,921 |
2,611 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
7,789 |
7,784 |
$122K |
| D1110 |
Prophylaxis - adult |
3,966 |
3,956 |
$122K |
| D0274 |
Bitewings - four radiographic images |
6,326 |
6,325 |
$94K |
| D1120 |
Prophylaxis - child |
2,400 |
2,396 |
$60K |
| D2752 |
|
91 |
84 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
2,085 |
2,035 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,303 |
4,295 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,249 |
4,228 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,759 |
1,758 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
230 |
203 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
345 |
296 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,400 |
1,400 |
$14K |
| D1320 |
|
1,705 |
1,699 |
$11K |
| D2160 |
|
229 |
205 |
$10K |
| D2753 |
|
19 |
19 |
$10K |
| D2954 |
|
93 |
89 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
94 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
127 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
76 |
$4K |
| D2335 |
|
49 |
38 |
$4K |
| D9110 |
|
190 |
185 |
$3K |
| D0272 |
Bitewings - two radiographic images |
271 |
271 |
$2K |
| D2920 |
|
93 |
85 |
$2K |
| D0330 |
Panoramic radiographic image |
87 |
87 |
$2K |