| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,063 |
9,007 |
$610K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,014 |
4,566 |
$534K |
| D2740 |
Crown - porcelain/ceramic |
1,086 |
797 |
$515K |
| D1120 |
Prophylaxis - child |
12,082 |
12,022 |
$510K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,501 |
6,485 |
$432K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,794 |
17,838 |
$224K |
| D9430 |
|
6,538 |
6,132 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,712 |
960 |
$202K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,757 |
13,679 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
4,072 |
4,053 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,486 |
2,067 |
$188K |
| D0350 |
|
12,906 |
7,390 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,122 |
3,439 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,811 |
1,284 |
$144K |
| D1110 |
Prophylaxis - adult |
1,460 |
1,452 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,912 |
1,200 |
$108K |
| D4341 |
|
1,487 |
427 |
$103K |
| D1310 |
|
1,909 |
1,892 |
$85K |
| D1320 |
|
6,435 |
6,403 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
686 |
370 |
$79K |
| D0272 |
Bitewings - two radiographic images |
6,543 |
6,499 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
6,259 |
5,848 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,375 |
3,361 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
647 |
335 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
855 |
854 |
$58K |
| D1351 |
Sealant - per tooth |
1,677 |
590 |
$53K |
| D4910 |
|
565 |
562 |
$43K |
| D0330 |
Panoramic radiographic image |
1,390 |
1,381 |
$40K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
79 |
64 |
$38K |
| D0270 |
|
6,136 |
5,324 |
$30K |
| D4342 |
|
714 |
222 |
$30K |
| D2335 |
|
163 |
100 |
$19K |
| D2330 |
|
210 |
130 |
$16K |
| D0603 |
|
995 |
987 |
$15K |
| D0601 |
|
824 |
824 |
$12K |
| D7220 |
|
19 |
13 |
$2K |
| D9920 |
|
269 |
228 |
$560.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$230.00 |
| D1330 |
|
370 |
340 |
$0.00 |