| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,889 |
7,848 |
$454K |
| D1120 |
Prophylaxis - child |
10,148 |
10,100 |
$383K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,213 |
9,982 |
$220K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,397 |
11,339 |
$139K |
| D1351 |
Sealant - per tooth |
5,594 |
1,498 |
$123K |
| D0274 |
Bitewings - four radiographic images |
5,680 |
5,655 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,080 |
2,077 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,636 |
778 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,389 |
644 |
$92K |
| D8670 |
Periodic orthodontic treatment visit |
168 |
167 |
$49K |
| D2140 |
|
836 |
396 |
$46K |
| D1310 |
|
818 |
817 |
$37K |
| D9993 |
|
564 |
564 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
275 |
95 |
$30K |
| D0350 |
|
1,256 |
1,197 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
583 |
582 |
$26K |
| D1110 |
Prophylaxis - adult |
351 |
348 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
245 |
81 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
608 |
595 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,793 |
1,767 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
75 |
37 |
$17K |
| D0330 |
Panoramic radiographic image |
451 |
450 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,019 |
1,019 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
298 |
$10K |
| D9430 |
|
260 |
256 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
48 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
72 |
$7K |
| D0603 |
|
403 |
403 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
61 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
35 |
35 |
$1K |
| D0601 |
|
77 |
77 |
$1K |