| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,088 |
18,008 |
$1.02M |
| D2740 |
Crown - porcelain/ceramic |
1,588 |
923 |
$748K |
| D1120 |
Prophylaxis - child |
19,229 |
19,136 |
$734K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,758 |
10,692 |
$693K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,625 |
6,320 |
$641K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,454 |
6,580 |
$615K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,795 |
1,898 |
$493K |
| D2330 |
|
6,216 |
2,979 |
$456K |
| D0210 |
Intraoral - complete series of radiographic images |
9,251 |
9,205 |
$437K |
| D1110 |
Prophylaxis - adult |
4,748 |
4,716 |
$417K |
| D1206 |
Topical application of fluoride varnish |
23,991 |
23,866 |
$327K |
| D1351 |
Sealant - per tooth |
10,881 |
3,885 |
$284K |
| D0274 |
Bitewings - four radiographic images |
10,187 |
10,141 |
$214K |
| D5130 |
|
343 |
333 |
$214K |
| D0330 |
Panoramic radiographic image |
7,069 |
7,024 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,367 |
1,866 |
$188K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,457 |
647 |
$165K |
| D9430 |
|
5,098 |
4,801 |
$158K |
| D5140 |
|
215 |
203 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,984 |
10,165 |
$122K |
| D0350 |
|
10,024 |
5,283 |
$105K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
226 |
208 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,158 |
801 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,456 |
6,322 |
$76K |
| D4341 |
|
988 |
404 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,045 |
1,040 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,602 |
5,577 |
$66K |
| D1310 |
|
1,422 |
1,411 |
$55K |
| D5750 |
|
232 |
228 |
$43K |
| D2140 |
|
755 |
547 |
$40K |
| D5850 |
|
584 |
559 |
$40K |
| D4910 |
|
441 |
436 |
$33K |
| D3320 |
|
90 |
77 |
$33K |
| D2331 |
|
414 |
312 |
$31K |
| D5851 |
|
423 |
408 |
$29K |
| D5110 |
|
36 |
36 |
$23K |
| D2160 |
|
255 |
209 |
$20K |
| D2954 |
|
142 |
98 |
$15K |
| D0603 |
|
866 |
858 |
$11K |
| D4342 |
|
174 |
81 |
$7K |
| D3310 |
|
19 |
14 |
$6K |
| D5751 |
|
28 |
27 |
$5K |
| D0601 |
|
330 |
327 |
$5K |
| D5211 |
|
13 |
13 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
28 |
$4K |
| D2332 |
|
24 |
18 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
14 |
$2K |