| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,929 |
18,908 |
$1.13M |
| D1120 |
Prophylaxis - child |
20,927 |
20,875 |
$807K |
| D1110 |
Prophylaxis - adult |
8,797 |
8,779 |
$734K |
| D1351 |
Sealant - per tooth |
22,480 |
5,751 |
$644K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,043 |
10,011 |
$615K |
| D0230 |
Intraoral - periapical each additional radiographic image |
136,245 |
27,442 |
$550K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
989 |
804 |
$470K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,904 |
4,121 |
$449K |
| D4341 |
|
5,728 |
1,607 |
$396K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,363 |
3,421 |
$356K |
| D0210 |
Intraoral - complete series of radiographic images |
7,320 |
7,297 |
$338K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,237 |
24,194 |
$294K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,496 |
1,275 |
$291K |
| D2140 |
|
4,763 |
2,834 |
$257K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,548 |
1,307 |
$252K |
| D0274 |
Bitewings - four radiographic images |
10,594 |
10,577 |
$225K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,710 |
5,567 |
$224K |
| D1310 |
|
4,889 |
4,887 |
$222K |
| D4910 |
|
2,610 |
2,610 |
$200K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
388 |
350 |
$180K |
| D9430 |
|
5,728 |
5,584 |
$179K |
| D0220 |
Intraoral - periapical first radiographic image |
14,124 |
13,412 |
$166K |
| D2330 |
|
2,142 |
1,197 |
$161K |
| D9993 |
|
2,281 |
2,281 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,345 |
1,625 |
$126K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,043 |
2,038 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,015 |
717 |
$118K |
| D3320 |
|
319 |
260 |
$116K |
| D1206 |
Topical application of fluoride varnish |
5,532 |
5,512 |
$113K |
| D1320 |
|
6,879 |
6,877 |
$104K |
| D0350 |
|
9,113 |
5,977 |
$92K |
| D4342 |
|
1,910 |
650 |
$80K |
| D0272 |
Bitewings - two radiographic images |
4,887 |
4,873 |
$57K |
| D2931 |
|
411 |
338 |
$51K |
| D2952 |
|
396 |
347 |
$41K |
| D0330 |
Panoramic radiographic image |
1,319 |
1,318 |
$38K |
| D0601 |
|
2,541 |
2,540 |
$38K |
| D2954 |
|
317 |
247 |
$33K |
| D2331 |
|
326 |
242 |
$26K |
| D0603 |
|
1,275 |
1,275 |
$19K |
| D2160 |
|
212 |
176 |
$17K |
| D1354 |
|
445 |
445 |
$15K |
| D5211 |
|
40 |
40 |
$14K |
| D0602 |
|
843 |
843 |
$13K |
| D3310 |
|
32 |
24 |
$10K |
| D1510 |
|
37 |
28 |
$4K |
| D7230 |
|
22 |
12 |
$4K |
| D0270 |
|
30 |
30 |
$100.00 |