| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,782 |
7,725 |
$403K |
| D0120 |
Periodic oral evaluation - established patient |
4,003 |
4,003 |
$301K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,504 |
4,448 |
$299K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,849 |
1,716 |
$258K |
| D1351 |
Sealant - per tooth |
5,833 |
1,601 |
$218K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,321 |
8,139 |
$179K |
| D2140 |
|
2,854 |
1,368 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,420 |
8,360 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,518 |
1,207 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,087 |
446 |
$130K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,089 |
436 |
$108K |
| D1310 |
|
2,060 |
2,047 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,153 |
3,131 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
547 |
268 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
2,654 |
2,615 |
$32K |
| D0603 |
|
2,060 |
2,047 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
591 |
591 |
$28K |
| D2160 |
|
344 |
220 |
$27K |
| D1110 |
Prophylaxis - adult |
290 |
287 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,025 |
2,002 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
542 |
528 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
301 |
$21K |
| D8670 |
Periodic orthodontic treatment visit |
63 |
63 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
39 |
38 |
$18K |
| D0350 |
|
628 |
595 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
359 |
359 |
$13K |
| D0330 |
Panoramic radiographic image |
359 |
359 |
$11K |
| D4341 |
|
108 |
30 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D9430 |
|
95 |
94 |
$3K |
| D1510 |
|
14 |
13 |
$3K |
| D2330 |
|
22 |
15 |
$2K |
| D2954 |
|
13 |
13 |
$1K |