| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,260 |
9,231 |
$505K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,394 |
3,658 |
$423K |
| D1120 |
Prophylaxis - child |
9,550 |
9,521 |
$365K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,797 |
4,783 |
$301K |
| D1351 |
Sealant - per tooth |
10,166 |
3,230 |
$290K |
| D1110 |
Prophylaxis - adult |
2,861 |
2,850 |
$244K |
| D2140 |
|
3,482 |
2,238 |
$188K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
367 |
290 |
$173K |
| D0210 |
Intraoral - complete series of radiographic images |
3,275 |
3,263 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,233 |
9,202 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,190 |
6,334 |
$102K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,348 |
2,204 |
$92K |
| D2330 |
|
1,201 |
639 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,582 |
973 |
$89K |
| D1310 |
|
1,412 |
1,412 |
$64K |
| D0272 |
Bitewings - two radiographic images |
5,151 |
5,135 |
$60K |
| D9993 |
|
855 |
855 |
$55K |
| D2160 |
|
490 |
393 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,739 |
1,739 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
338 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,152 |
2,140 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
169 |
126 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
156 |
$14K |
| D2954 |
|
95 |
83 |
$10K |
| D0350 |
|
1,203 |
740 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
49 |
$8K |
| D2931 |
|
59 |
49 |
$7K |
| D0603 |
|
436 |
435 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$6K |
| D9430 |
|
116 |
116 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$2K |
| D0601 |
|
81 |
81 |
$1K |
| D7111 |
|
19 |
12 |
$1K |
| D3221 |
|
15 |
13 |
$945.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$677.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$302.40 |