| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,102 |
7,071 |
$387K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,490 |
5,468 |
$322K |
| D1120 |
Prophylaxis - child |
7,921 |
7,894 |
$303K |
| D1351 |
Sealant - per tooth |
10,005 |
2,662 |
$281K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,268 |
1,366 |
$265K |
| D1110 |
Prophylaxis - adult |
3,061 |
3,045 |
$260K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
391 |
340 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,010 |
1,561 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,786 |
11,328 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,151 |
1,511 |
$142K |
| D0274 |
Bitewings - four radiographic images |
6,728 |
6,701 |
$140K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,103 |
1,397 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,736 |
10,701 |
$131K |
| D0350 |
|
10,188 |
5,359 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,573 |
1,071 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
6,462 |
6,381 |
$76K |
| D9430 |
|
2,178 |
2,145 |
$69K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
123 |
112 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,162 |
1,153 |
$55K |
| D2330 |
|
578 |
384 |
$44K |
| D2140 |
|
728 |
538 |
$39K |
| D1310 |
|
793 |
792 |
$36K |
| D2954 |
|
327 |
280 |
$34K |
| D4341 |
|
383 |
140 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
259 |
$25K |
| D9993 |
|
694 |
692 |
$20K |
| D0601 |
|
829 |
826 |
$10K |
| D2331 |
|
58 |
45 |
$5K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$1K |
| D9110 |
|
13 |
13 |
$819.00 |