| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,592 |
3,585 |
$236K |
| D1120 |
Prophylaxis - child |
3,400 |
3,384 |
$170K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,911 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
2,086 |
$155K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
302 |
225 |
$143K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,674 |
870 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,851 |
1,847 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,429 |
5,408 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
725 |
483 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,049 |
3,859 |
$79K |
| D4341 |
|
648 |
171 |
$45K |
| D1351 |
Sealant - per tooth |
1,173 |
313 |
$43K |
| D1310 |
|
866 |
854 |
$39K |
| D0350 |
|
1,696 |
1,367 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,658 |
$35K |
| D3221 |
|
484 |
371 |
$30K |
| D2954 |
|
288 |
216 |
$30K |
| D2140 |
|
530 |
316 |
$29K |
| D2160 |
|
330 |
228 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
435 |
232 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,985 |
1,891 |
$24K |
| D4910 |
|
304 |
304 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
43 |
40 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
452 |
422 |
$18K |
| D9430 |
|
565 |
553 |
$18K |
| D0272 |
Bitewings - two radiographic images |
995 |
993 |
$11K |
| D4342 |
|
155 |
44 |
$7K |
| D0603 |
|
441 |
436 |
$7K |
| D0602 |
|
219 |
216 |
$3K |
| D0330 |
Panoramic radiographic image |
108 |
108 |
$3K |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$885.00 |