| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,089 |
12,032 |
$668K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
988 |
666 |
$469K |
| D1120 |
Prophylaxis - child |
12,140 |
12,089 |
$446K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,262 |
2,427 |
$284K |
| D4910 |
|
3,586 |
3,563 |
$276K |
| D1351 |
Sealant - per tooth |
9,547 |
2,835 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,312 |
4,293 |
$255K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,639 |
13,256 |
$253K |
| D1110 |
Prophylaxis - adult |
2,948 |
2,930 |
$239K |
| D4341 |
|
3,263 |
923 |
$219K |
| D2160 |
|
2,724 |
1,695 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,706 |
14,637 |
$188K |
| D0210 |
Intraoral - complete series of radiographic images |
4,028 |
4,009 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,088 |
1,461 |
$176K |
| D0274 |
Bitewings - four radiographic images |
7,630 |
7,592 |
$148K |
| D1310 |
|
2,197 |
2,181 |
$97K |
| D9993 |
|
1,284 |
1,279 |
$79K |
| D9430 |
|
2,549 |
2,431 |
$78K |
| D2954 |
|
729 |
523 |
$77K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
165 |
148 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,849 |
5,641 |
$67K |
| D2140 |
|
969 |
680 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
403 |
267 |
$47K |
| D4342 |
|
1,038 |
351 |
$43K |
| D0350 |
|
3,910 |
2,295 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
728 |
721 |
$28K |
| D2330 |
|
325 |
185 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,084 |
2,079 |
$23K |
| D3320 |
|
61 |
53 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
229 |
$22K |
| D3310 |
|
61 |
37 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
187 |
78 |
$18K |
| D0602 |
|
1,057 |
1,050 |
$15K |
| D0603 |
|
944 |
938 |
$14K |
| D0330 |
Panoramic radiographic image |
412 |
411 |
$11K |
| D2161 |
|
115 |
97 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
82 |
$8K |
| D7230 |
|
30 |
14 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
36 |
$3K |
| D9248 |
|
12 |
12 |
$270.00 |
| D1999 |
|
13 |
13 |
$10.00 |