| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,251 |
10,196 |
$600K |
| D1120 |
Prophylaxis - child |
10,334 |
10,272 |
$405K |
| D1110 |
Prophylaxis - adult |
4,176 |
4,157 |
$349K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,556 |
4,534 |
$287K |
| D1206 |
Topical application of fluoride varnish |
13,144 |
13,070 |
$177K |
| D0274 |
Bitewings - four radiographic images |
7,883 |
7,849 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,225 |
694 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,466 |
2,453 |
$112K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
234 |
190 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,583 |
975 |
$105K |
| D1351 |
Sealant - per tooth |
4,259 |
1,114 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,888 |
12,645 |
$102K |
| D9430 |
|
3,131 |
3,035 |
$98K |
| D1310 |
|
2,601 |
2,578 |
$92K |
| D9993 |
|
1,451 |
1,441 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
891 |
560 |
$57K |
| D2140 |
|
884 |
591 |
$48K |
| D4910 |
|
637 |
624 |
$46K |
| D4341 |
|
644 |
202 |
$43K |
| D0603 |
|
2,591 |
2,569 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,156 |
3,103 |
$37K |
| D0330 |
Panoramic radiographic image |
1,202 |
1,192 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
505 |
331 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,230 |
2,218 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
236 |
$21K |
| D2160 |
|
260 |
203 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,075 |
1,073 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
150 |
$14K |
| D2954 |
|
47 |
41 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
17 |
$880.00 |
| D0270 |
|
124 |
123 |
$605.00 |
| D0250 |
|
12 |
12 |
$264.00 |