| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,612 |
17,559 |
$981K |
| D1120 |
Prophylaxis - child |
18,835 |
18,768 |
$731K |
| D0230 |
Intraoral - periapical each additional radiographic image |
115,537 |
19,128 |
$467K |
| D1351 |
Sealant - per tooth |
11,637 |
3,094 |
$319K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,443 |
2,542 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,433 |
20,361 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,943 |
2,935 |
$188K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,618 |
884 |
$160K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,313 |
737 |
$153K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,993 |
1,252 |
$134K |
| D0272 |
Bitewings - two radiographic images |
10,034 |
10,018 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
9,733 |
9,664 |
$115K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
228 |
178 |
$108K |
| D4341 |
|
1,447 |
381 |
$101K |
| D2140 |
|
1,823 |
1,159 |
$99K |
| D1310 |
|
2,134 |
2,124 |
$94K |
| D1110 |
Prophylaxis - adult |
980 |
976 |
$81K |
| D9430 |
|
1,685 |
1,666 |
$53K |
| D4910 |
|
692 |
692 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
763 |
752 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
430 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
815 |
807 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
532 |
319 |
$36K |
| D0350 |
|
3,356 |
1,746 |
$33K |
| D0603 |
|
1,635 |
1,631 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
39 |
$19K |
| D9993 |
|
309 |
309 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
110 |
$17K |
| D1320 |
|
784 |
782 |
$11K |
| D0330 |
Panoramic radiographic image |
352 |
350 |
$10K |
| D2954 |
|
92 |
68 |
$10K |
| D0274 |
Bitewings - four radiographic images |
352 |
352 |
$8K |
| D0602 |
|
311 |
308 |
$5K |
| D4342 |
|
97 |
30 |
$4K |
| D1354 |
|
136 |
45 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$1K |
| D7111 |
|
15 |
14 |
$861.00 |
| D0260 |
|
67 |
36 |
$335.00 |