| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,225 |
8,195 |
$466K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,069 |
1,865 |
$361K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,345 |
3,390 |
$357K |
| D1120 |
Prophylaxis - child |
8,603 |
8,533 |
$337K |
| D0230 |
Intraoral - periapical each additional radiographic image |
76,286 |
15,903 |
$311K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,695 |
4,668 |
$299K |
| D2140 |
|
3,160 |
2,069 |
$170K |
| D0274 |
Bitewings - four radiographic images |
7,413 |
7,378 |
$154K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,203 |
742 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,456 |
1,311 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,319 |
9,278 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,161 |
720 |
$114K |
| D9430 |
|
2,443 |
2,426 |
$77K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
150 |
128 |
$71K |
| D1310 |
|
1,470 |
1,467 |
$67K |
| D1351 |
Sealant - per tooth |
1,942 |
585 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,576 |
1,515 |
$62K |
| D0350 |
|
5,785 |
3,089 |
$56K |
| D2160 |
|
675 |
504 |
$53K |
| D9993 |
|
642 |
642 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
759 |
753 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,940 |
2,918 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,496 |
2,490 |
$29K |
| D4341 |
|
209 |
58 |
$15K |
| D0603 |
|
845 |
845 |
$13K |
| D2330 |
|
137 |
87 |
$10K |
| D1110 |
Prophylaxis - adult |
103 |
102 |
$9K |
| D0270 |
|
759 |
755 |
$4K |
| D2931 |
|
14 |
12 |
$2K |
| D2954 |
|
13 |
12 |
$1K |
| D0602 |
|
68 |
68 |
$1K |