| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,983 |
14,936 |
$882K |
| D1110 |
Prophylaxis - adult |
8,261 |
8,234 |
$716K |
| D4341 |
|
7,981 |
2,435 |
$557K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,946 |
4,083 |
$464K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
908 |
575 |
$431K |
| D1120 |
Prophylaxis - child |
9,408 |
9,384 |
$361K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85,281 |
15,035 |
$339K |
| D4910 |
|
3,911 |
3,902 |
$301K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,997 |
2,965 |
$285K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,904 |
3,898 |
$234K |
| D2140 |
|
4,278 |
2,661 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,862 |
17,811 |
$222K |
| D0274 |
Bitewings - four radiographic images |
10,239 |
10,209 |
$219K |
| D4342 |
|
4,180 |
1,464 |
$175K |
| D9430 |
|
5,239 |
4,929 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
3,354 |
3,347 |
$159K |
| D2160 |
|
1,507 |
1,216 |
$120K |
| D2952 |
|
917 |
596 |
$96K |
| D1351 |
Sealant - per tooth |
3,605 |
874 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,983 |
6,576 |
$83K |
| D2335 |
|
685 |
389 |
$81K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
149 |
142 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,872 |
1,760 |
$67K |
| D2330 |
|
632 |
388 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
862 |
448 |
$47K |
| D1310 |
|
865 |
864 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,403 |
2,397 |
$28K |
| D9993 |
|
826 |
825 |
$22K |
| D3320 |
|
48 |
39 |
$18K |
| D3310 |
|
38 |
25 |
$11K |
| D2332 |
|
42 |
14 |
$3K |
| D0601 |
|
97 |
96 |
$1K |
| D0602 |
|
53 |
53 |
$765.00 |