| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,978 |
24,852 |
$937K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,004 |
6,539 |
$924K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,289 |
15,267 |
$903K |
| D0120 |
Periodic oral evaluation - established patient |
15,518 |
15,460 |
$885K |
| D0230 |
Intraoral - periapical each additional radiographic image |
128,057 |
23,481 |
$551K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,982 |
4,662 |
$478K |
| D0210 |
Intraoral - complete series of radiographic images |
8,608 |
8,594 |
$390K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,283 |
1,290 |
$375K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,525 |
2,729 |
$356K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,158 |
2,474 |
$339K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,735 |
24,624 |
$325K |
| D1351 |
Sealant - per tooth |
11,034 |
3,472 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,046 |
2,898 |
$284K |
| D1110 |
Prophylaxis - adult |
3,201 |
3,188 |
$265K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,350 |
6,205 |
$248K |
| D1310 |
|
4,899 |
4,881 |
$222K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,828 |
829 |
$180K |
| D2330 |
|
2,347 |
1,281 |
$174K |
| D9993 |
|
2,644 |
2,642 |
$170K |
| D2140 |
|
2,944 |
1,552 |
$156K |
| D0220 |
Intraoral - periapical first radiographic image |
12,598 |
12,519 |
$146K |
| D3240 |
|
1,276 |
579 |
$123K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,753 |
1,747 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,345 |
4,334 |
$93K |
| D9248 |
|
2,560 |
2,500 |
$85K |
| D0272 |
Bitewings - two radiographic images |
6,516 |
6,498 |
$77K |
| D2160 |
|
720 |
503 |
$56K |
| D2390 |
|
562 |
254 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,745 |
2,735 |
$49K |
| D9430 |
|
1,458 |
1,433 |
$46K |
| D3230 |
|
457 |
195 |
$44K |
| D4341 |
|
538 |
152 |
$36K |
| D2394 |
|
404 |
294 |
$34K |
| D0603 |
|
2,215 |
2,206 |
$33K |
| D0602 |
|
1,879 |
1,875 |
$28K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
40 |
30 |
$19K |
| D2952 |
|
171 |
134 |
$18K |
| D2332 |
|
224 |
136 |
$18K |
| D2335 |
|
144 |
80 |
$17K |
| D1510 |
|
159 |
129 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$13K |
| D3320 |
|
33 |
27 |
$12K |
| D7111 |
|
205 |
105 |
$11K |
| D2791 |
|
15 |
13 |
$7K |
| D3221 |
|
107 |
83 |
$7K |
| D2331 |
|
60 |
40 |
$5K |
| D0601 |
|
296 |
296 |
$4K |
| D2932 |
|
26 |
12 |
$3K |