| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,391 |
8,366 |
$416K |
| D0120 |
Periodic oral evaluation - established patient |
5,314 |
5,299 |
$372K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,783 |
3,777 |
$253K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,353 |
1,493 |
$225K |
| D1310 |
|
4,632 |
4,616 |
$212K |
| D2140 |
|
3,794 |
1,550 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,507 |
10,474 |
$206K |
| D1110 |
Prophylaxis - adult |
2,095 |
2,092 |
$187K |
| D2330 |
|
1,600 |
758 |
$126K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
256 |
163 |
$122K |
| D1351 |
Sealant - per tooth |
2,951 |
985 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,560 |
1,553 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,121 |
7,102 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,498 |
944 |
$86K |
| D0603 |
|
4,581 |
4,565 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,851 |
2,848 |
$62K |
| D4341 |
|
727 |
192 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
424 |
182 |
$51K |
| D0350 |
|
4,614 |
2,098 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
392 |
164 |
$39K |
| D9993 |
|
568 |
568 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
854 |
834 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,791 |
2,786 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
567 |
268 |
$31K |
| D4910 |
|
384 |
384 |
$30K |
| D2954 |
|
279 |
182 |
$29K |
| D0330 |
Panoramic radiographic image |
813 |
809 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
33 |
30 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
81 |
$11K |
| D2160 |
|
108 |
83 |
$9K |
| D0272 |
Bitewings - two radiographic images |
664 |
664 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
24 |
$4K |