| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,449 |
11,409 |
$611K |
| D1351 |
Sealant - per tooth |
17,708 |
4,901 |
$494K |
| D1120 |
Prophylaxis - child |
11,337 |
11,289 |
$428K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75,722 |
15,684 |
$310K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,298 |
1,540 |
$269K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,998 |
2,528 |
$267K |
| D1110 |
Prophylaxis - adult |
2,816 |
2,803 |
$242K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
482 |
434 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,157 |
3,149 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
13,889 |
12,950 |
$164K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
343 |
274 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,154 |
14,091 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,365 |
1,690 |
$135K |
| D9430 |
|
4,093 |
3,973 |
$129K |
| D2160 |
|
1,346 |
1,022 |
$107K |
| D0272 |
Bitewings - two radiographic images |
7,841 |
7,813 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,280 |
956 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,523 |
1,083 |
$82K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
750 |
516 |
$74K |
| D1310 |
|
1,515 |
1,514 |
$69K |
| D9993 |
|
1,510 |
1,509 |
$63K |
| D0350 |
|
6,800 |
3,955 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
929 |
777 |
$36K |
| D2952 |
|
293 |
235 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
577 |
570 |
$27K |
| D2140 |
|
407 |
294 |
$22K |
| D3320 |
|
59 |
53 |
$22K |
| D2330 |
|
253 |
167 |
$19K |
| D2331 |
|
219 |
150 |
$17K |
| D4341 |
|
231 |
64 |
$16K |
| D0603 |
|
693 |
691 |
$10K |
| D3310 |
|
20 |
12 |
$6K |
| D2332 |
|
63 |
39 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
104 |
104 |
$5K |
| D0601 |
|
304 |
304 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D4910 |
|
12 |
12 |
$924.00 |