| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,579 |
9,551 |
$546K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,349 |
6,334 |
$396K |
| D1120 |
Prophylaxis - child |
9,805 |
9,777 |
$381K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,203 |
14,617 |
$363K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
729 |
572 |
$347K |
| D1110 |
Prophylaxis - adult |
2,982 |
2,965 |
$254K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,375 |
1,930 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,348 |
12,309 |
$145K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,163 |
809 |
$137K |
| D0274 |
Bitewings - four radiographic images |
5,641 |
5,614 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,638 |
907 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,898 |
1,894 |
$78K |
| D2140 |
|
1,407 |
734 |
$77K |
| D1351 |
Sealant - per tooth |
2,544 |
643 |
$70K |
| D0272 |
Bitewings - two radiographic images |
5,090 |
5,081 |
$60K |
| D2954 |
|
559 |
467 |
$58K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
111 |
109 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
891 |
442 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
96 |
77 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,524 |
3,503 |
$41K |
| D2160 |
|
486 |
368 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
226 |
$28K |
| D1206 |
Topical application of fluoride varnish |
923 |
923 |
$16K |
| D4341 |
|
200 |
61 |
$14K |
| D9430 |
|
441 |
437 |
$12K |
| D4910 |
|
70 |
70 |
$5K |
| D2931 |
|
33 |
28 |
$4K |
| D2330 |
|
53 |
27 |
$4K |
| D0350 |
|
462 |
191 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
25 |
$3K |
| D1310 |
|
44 |
43 |
$2K |
| D9993 |
|
31 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$780.00 |