| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,466 |
13,452 |
$853K |
| D1120 |
Prophylaxis - child |
18,154 |
18,139 |
$751K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,191 |
7,183 |
$478K |
| D1351 |
Sealant - per tooth |
14,172 |
4,343 |
$409K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,793 |
17,054 |
$376K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,105 |
2,583 |
$342K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,656 |
22,632 |
$326K |
| D1110 |
Prophylaxis - adult |
3,186 |
3,183 |
$275K |
| D2140 |
|
4,846 |
2,356 |
$264K |
| D1310 |
|
5,409 |
5,407 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,445 |
1,879 |
$196K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,564 |
742 |
$187K |
| D9993 |
|
2,385 |
2,384 |
$153K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,506 |
725 |
$149K |
| D0272 |
Bitewings - two radiographic images |
8,830 |
8,825 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,595 |
671 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,712 |
1,711 |
$81K |
| D0350 |
|
4,018 |
3,727 |
$71K |
| D0603 |
|
4,054 |
4,053 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,006 |
4,980 |
$60K |
| D4341 |
|
612 |
160 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,885 |
1,883 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
327 |
218 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
536 |
268 |
$36K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
51 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
357 |
357 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
516 |
499 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
30 |
27 |
$14K |
| D0601 |
|
909 |
909 |
$13K |
| D9430 |
|
252 |
248 |
$8K |
| D4910 |
|
85 |
85 |
$7K |
| D2160 |
|
80 |
54 |
$6K |
| D2330 |
|
83 |
55 |
$6K |
| D2954 |
|
30 |
27 |
$3K |
| D1354 |
|
77 |
77 |
$3K |
| D2331 |
|
14 |
13 |
$1K |
| D9920 |
|
12 |
12 |
$140.00 |