| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,484 |
7,477 |
$436K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,264 |
5,252 |
$335K |
| D1120 |
Prophylaxis - child |
7,685 |
7,673 |
$310K |
| D1110 |
Prophylaxis - adult |
3,275 |
3,270 |
$277K |
| D1351 |
Sealant - per tooth |
8,331 |
2,287 |
$242K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
454 |
322 |
$215K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,532 |
10,030 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,506 |
1,193 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
3,358 |
3,349 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,083 |
11,067 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,202 |
1,033 |
$143K |
| D0274 |
Bitewings - four radiographic images |
5,652 |
5,650 |
$119K |
| D4341 |
|
1,462 |
412 |
$101K |
| D9430 |
|
2,852 |
2,771 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,548 |
716 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
683 |
362 |
$80K |
| D2160 |
|
813 |
502 |
$65K |
| D0350 |
|
5,543 |
2,450 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
682 |
461 |
$52K |
| D4910 |
|
618 |
618 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,658 |
3,515 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
762 |
315 |
$43K |
| D2140 |
|
550 |
308 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,241 |
2,239 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
48 |
35 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
524 |
523 |
$21K |
| D0330 |
Panoramic radiographic image |
521 |
520 |
$15K |
| D2954 |
|
145 |
116 |
$15K |
| D0340 |
|
52 |
52 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
13 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$2K |