| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,329 |
3,328 |
$211K |
| D1120 |
Prophylaxis - child |
5,292 |
5,277 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
3,349 |
3,341 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,929 |
5,707 |
$120K |
| D1110 |
Prophylaxis - adult |
1,175 |
1,174 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,064 |
7,037 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
750 |
433 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,843 |
1,842 |
$87K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
996 |
424 |
$66K |
| D1351 |
Sealant - per tooth |
2,626 |
672 |
$62K |
| D1310 |
|
1,205 |
1,205 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,281 |
2,273 |
$49K |
| D9993 |
|
736 |
736 |
$47K |
| D4910 |
|
485 |
484 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
414 |
186 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,950 |
1,923 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
529 |
515 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
165 |
59 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
119 |
46 |
$14K |
| D0603 |
|
951 |
951 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
106 |
$13K |
| D0350 |
|
598 |
554 |
$11K |
| D2140 |
|
175 |
89 |
$10K |
| D4341 |
|
122 |
37 |
$9K |
| D0272 |
Bitewings - two radiographic images |
702 |
702 |
$8K |
| D9430 |
|
101 |
96 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
88 |
$3K |
| D1320 |
|
213 |
213 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$2K |
| D4342 |
|
37 |
12 |
$2K |
| D0602 |
|
85 |
85 |
$1K |
| D0601 |
|
32 |
32 |
$465.00 |