| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
17,851 |
6,190 |
$1.37M |
| D0120 |
Periodic oral evaluation - established patient |
16,007 |
15,945 |
$931K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,698 |
6,173 |
$850K |
| D2160 |
|
10,631 |
5,745 |
$843K |
| D1120 |
Prophylaxis - child |
19,965 |
19,890 |
$780K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,905 |
5,510 |
$682K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,956 |
28,207 |
$630K |
| D2335 |
|
5,016 |
3,017 |
$585K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,646 |
13,721 |
$581K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,309 |
1,426 |
$505K |
| D2161 |
|
5,857 |
3,340 |
$486K |
| D1351 |
Sealant - per tooth |
16,455 |
4,929 |
$467K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,165 |
1,364 |
$413K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
840 |
590 |
$400K |
| D2332 |
|
4,232 |
2,609 |
$376K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,683 |
23,600 |
$352K |
| D1310 |
|
7,767 |
7,746 |
$352K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,616 |
5,606 |
$351K |
| D9993 |
|
4,306 |
4,304 |
$276K |
| D1110 |
Prophylaxis - adult |
2,301 |
2,299 |
$187K |
| D0272 |
Bitewings - two radiographic images |
13,808 |
13,768 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
15,136 |
14,583 |
$161K |
| D0350 |
|
9,281 |
7,613 |
$159K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
330 |
290 |
$153K |
| D4341 |
|
2,233 |
589 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
3,125 |
3,120 |
$145K |
| D1354 |
|
5,457 |
3,350 |
$113K |
| D0603 |
|
7,641 |
7,620 |
$113K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,650 |
1,649 |
$94K |
| D9430 |
|
2,708 |
2,562 |
$85K |
| D2952 |
|
803 |
579 |
$84K |
| D2140 |
|
1,519 |
897 |
$82K |
| D4910 |
|
1,030 |
1,029 |
$77K |
| D1320 |
|
4,957 |
4,939 |
$60K |
| D9910 |
|
686 |
686 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
285 |
203 |
$34K |
| D3320 |
|
63 |
52 |
$23K |
| D7510 |
|
339 |
328 |
$21K |
| D2331 |
|
198 |
146 |
$16K |
| D3310 |
|
39 |
24 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
74 |
$8K |
| D1510 |
|
66 |
54 |
$8K |
| D2931 |
|
48 |
39 |
$6K |
| D4342 |
|
86 |
24 |
$4K |
| D5760 |
|
12 |
12 |
$2K |
| D0602 |
|
93 |
93 |
$1K |
| D2394 |
|
16 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
58 |
58 |
$1K |