| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,628 |
7,605 |
$416K |
| D1120 |
Prophylaxis - child |
8,403 |
8,369 |
$316K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,716 |
1,570 |
$250K |
| D2140 |
|
4,303 |
1,800 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,886 |
9,024 |
$191K |
| D1351 |
Sealant - per tooth |
5,267 |
1,737 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,130 |
2,118 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,739 |
8,702 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,726 |
824 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,140 |
4,127 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,667 |
1,656 |
$77K |
| D1110 |
Prophylaxis - adult |
773 |
769 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
451 |
296 |
$49K |
| D0350 |
|
4,766 |
2,276 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
624 |
271 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,248 |
3,198 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
483 |
255 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
276 |
102 |
$27K |
| D4341 |
|
407 |
105 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
651 |
633 |
$26K |
| D4910 |
|
332 |
328 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
85 |
$25K |
| D9430 |
|
766 |
751 |
$24K |
| D1310 |
|
447 |
447 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
29 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,321 |
$15K |
| D1206 |
Topical application of fluoride varnish |
332 |
330 |
$7K |
| D1320 |
|
471 |
470 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D9993 |
|
83 |
83 |
$5K |
| D2954 |
|
45 |
35 |
$5K |
| D2160 |
|
34 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0603 |
|
89 |
89 |
$1K |
| D4355 |
|
27 |
27 |
$0.00 |