| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,233 |
9,175 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
5,444 |
5,439 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,711 |
4,708 |
$306K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,352 |
10,066 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,990 |
1,339 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,294 |
11,238 |
$162K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
974 |
373 |
$116K |
| D1351 |
Sealant - per tooth |
4,190 |
1,171 |
$104K |
| D1110 |
Prophylaxis - adult |
994 |
994 |
$87K |
| D1310 |
|
1,847 |
1,847 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
846 |
320 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,348 |
632 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,633 |
1,632 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,114 |
3,108 |
$66K |
| D9993 |
|
996 |
996 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,350 |
1,304 |
$53K |
| D2140 |
|
973 |
451 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,981 |
2,949 |
$34K |
| D1320 |
|
2,308 |
2,305 |
$31K |
| D0350 |
|
1,501 |
1,325 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,127 |
2,107 |
$25K |
| D0603 |
|
1,546 |
1,546 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
58 |
58 |
$17K |
| D4341 |
|
239 |
73 |
$16K |
| D4910 |
|
126 |
126 |
$10K |
| D9430 |
|
274 |
272 |
$9K |
| D2160 |
|
103 |
66 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
185 |
185 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
90 |
90 |
$6K |
| D2330 |
|
62 |
32 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
28 |
$3K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$2K |
| D0602 |
|
42 |
42 |
$630.00 |
| D0601 |
|
14 |
14 |
$210.00 |