| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,123 |
17,045 |
$945K |
| D1120 |
Prophylaxis - child |
16,753 |
16,641 |
$636K |
| D4341 |
|
8,339 |
2,473 |
$572K |
| D0230 |
Intraoral - periapical each additional radiographic image |
115,066 |
23,400 |
$467K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,958 |
2,376 |
$467K |
| D0350 |
|
46,000 |
13,989 |
$437K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,343 |
5,323 |
$333K |
| D0210 |
Intraoral - complete series of radiographic images |
6,874 |
6,853 |
$326K |
| D4910 |
|
3,863 |
3,847 |
$297K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
589 |
445 |
$279K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,454 |
21,337 |
$279K |
| D1110 |
Prophylaxis - adult |
2,888 |
2,885 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,706 |
2,166 |
$247K |
| D9430 |
|
7,024 |
6,982 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,263 |
1,556 |
$216K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
360 |
333 |
$166K |
| D0274 |
Bitewings - four radiographic images |
7,042 |
7,003 |
$148K |
| D0220 |
Intraoral - periapical first radiographic image |
12,322 |
12,065 |
$145K |
| D4342 |
|
3,403 |
1,151 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,289 |
3,182 |
$129K |
| D1310 |
|
2,710 |
2,709 |
$123K |
| D1351 |
Sealant - per tooth |
4,291 |
1,231 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,981 |
1,147 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,982 |
1,246 |
$107K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
973 |
415 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
766 |
373 |
$92K |
| D9993 |
|
1,122 |
1,122 |
$68K |
| D0272 |
Bitewings - two radiographic images |
5,257 |
5,237 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
118 |
90 |
$56K |
| D2954 |
|
511 |
396 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
612 |
463 |
$49K |
| D3221 |
|
718 |
626 |
$45K |
| D0330 |
Panoramic radiographic image |
1,514 |
1,507 |
$44K |
| D2140 |
|
688 |
399 |
$38K |
| D3320 |
|
101 |
83 |
$37K |
| D0602 |
|
1,025 |
1,024 |
$15K |
| D0603 |
|
999 |
999 |
$15K |
| D2330 |
|
128 |
73 |
$10K |
| D2160 |
|
107 |
82 |
$8K |
| D3310 |
|
24 |
13 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$3K |
| D0270 |
|
59 |
59 |
$280.00 |