| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,145 |
2,122 |
$140K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
303 |
202 |
$139K |
| D1120 |
Prophylaxis - child |
2,801 |
2,771 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
1,749 |
1,731 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,821 |
722 |
$116K |
| D1351 |
Sealant - per tooth |
3,812 |
912 |
$116K |
| D1110 |
Prophylaxis - adult |
996 |
990 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,541 |
3,575 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,263 |
3,229 |
$56K |
| D4341 |
|
694 |
193 |
$48K |
| D1310 |
|
887 |
882 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
805 |
801 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
319 |
166 |
$36K |
| D9430 |
|
1,097 |
1,019 |
$33K |
| D4910 |
|
429 |
429 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
563 |
255 |
$31K |
| D2160 |
|
370 |
199 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,439 |
1,426 |
$28K |
| D2140 |
|
447 |
190 |
$24K |
| D2954 |
|
203 |
133 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,296 |
1,256 |
$13K |
| D0603 |
|
840 |
836 |
$12K |
| D0350 |
|
1,191 |
524 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,034 |
996 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
513 |
513 |
$9K |
| D2330 |
|
108 |
39 |
$8K |
| D9993 |
|
80 |
80 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
81 |
79 |
$3K |
| D0330 |
Panoramic radiographic image |
90 |
89 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$2K |
| D4342 |
|
38 |
13 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |