| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,243 |
7,206 |
$405K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,123 |
2,585 |
$403K |
| D1120 |
Prophylaxis - child |
9,054 |
8,968 |
$371K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
781 |
482 |
$370K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,139 |
5,126 |
$326K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,343 |
10,427 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,842 |
1,619 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
3,769 |
3,740 |
$176K |
| D4341 |
|
2,439 |
652 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,634 |
1,300 |
$150K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,271 |
10,169 |
$147K |
| D1351 |
Sealant - per tooth |
4,452 |
1,428 |
$139K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
291 |
225 |
$135K |
| D4260 |
|
266 |
69 |
$130K |
| D0350 |
|
11,284 |
4,734 |
$122K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,723 |
758 |
$115K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
931 |
408 |
$110K |
| D1110 |
Prophylaxis - adult |
1,164 |
1,162 |
$104K |
| D2954 |
|
906 |
522 |
$95K |
| D1310 |
|
1,985 |
1,978 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,237 |
2,205 |
$89K |
| D4910 |
|
1,083 |
1,082 |
$83K |
| D9430 |
|
2,557 |
2,467 |
$81K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
813 |
353 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
994 |
608 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,290 |
4,234 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,093 |
4,056 |
$49K |
| D1510 |
|
242 |
163 |
$46K |
| D0340 |
|
921 |
921 |
$46K |
| D2160 |
|
540 |
320 |
$43K |
| D0330 |
Panoramic radiographic image |
1,308 |
1,307 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
302 |
160 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
73 |
39 |
$35K |
| D1320 |
|
1,700 |
1,697 |
$26K |
| D3320 |
|
64 |
50 |
$23K |
| D0603 |
|
1,569 |
1,563 |
$23K |
| D9993 |
|
325 |
325 |
$21K |
| D2330 |
|
250 |
145 |
$19K |
| D7240 |
Removal of impacted tooth - completely bony |
73 |
33 |
$17K |
| D0274 |
Bitewings - four radiographic images |
606 |
605 |
$13K |
| D7241 |
|
37 |
12 |
$12K |
| D7230 |
|
64 |
38 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
141 |
141 |
$10K |
| D1206 |
Topical application of fluoride varnish |
502 |
502 |
$9K |
| D2161 |
|
60 |
37 |
$5K |
| D2394 |
|
24 |
13 |
$2K |
| D0270 |
|
200 |
198 |
$997.50 |
| D0602 |
|
26 |
26 |
$390.00 |