| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,635 |
10,463 |
$653K |
| D1120 |
Prophylaxis - child |
13,200 |
12,991 |
$511K |
| D1351 |
Sealant - per tooth |
13,051 |
3,315 |
$354K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79,540 |
16,181 |
$325K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,180 |
5,144 |
$315K |
| D1110 |
Prophylaxis - adult |
3,160 |
3,133 |
$263K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,483 |
1,898 |
$198K |
| D4341 |
|
2,427 |
669 |
$170K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,494 |
1,480 |
$167K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,708 |
3,626 |
$146K |
| D0210 |
Intraoral - complete series of radiographic images |
3,096 |
3,071 |
$144K |
| D1310 |
|
3,156 |
3,112 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,397 |
12,224 |
$141K |
| D0274 |
Bitewings - four radiographic images |
5,348 |
5,251 |
$113K |
| D4910 |
|
1,468 |
1,468 |
$113K |
| D9993 |
|
1,575 |
1,575 |
$99K |
| D2140 |
|
1,706 |
971 |
$92K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
178 |
145 |
$85K |
| D1206 |
Topical application of fluoride varnish |
3,871 |
3,818 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
5,719 |
5,615 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
544 |
251 |
$63K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
564 |
270 |
$56K |
| D9430 |
|
1,570 |
1,540 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
906 |
899 |
$49K |
| D1320 |
|
2,750 |
2,712 |
$41K |
| D2330 |
|
505 |
272 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,115 |
3,086 |
$37K |
| D0350 |
|
3,610 |
2,359 |
$37K |
| D0601 |
|
1,624 |
1,604 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
352 |
230 |
$19K |
| D0603 |
|
769 |
769 |
$11K |
| D4342 |
|
261 |
92 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
20 |
$9K |
| D1354 |
|
257 |
257 |
$8K |
| D2952 |
|
46 |
40 |
$5K |
| D0602 |
|
188 |
173 |
$3K |
| D1510 |
|
16 |
12 |
$2K |
| D2160 |
|
22 |
21 |
$2K |
| D2954 |
|
16 |
13 |
$2K |