| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,528 |
7,499 |
$418K |
| D1120 |
Prophylaxis - child |
10,584 |
10,528 |
$389K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,350 |
2,236 |
$355K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,617 |
10,278 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,461 |
3,450 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,054 |
11,988 |
$163K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,350 |
514 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,570 |
1,278 |
$147K |
| D1351 |
Sealant - per tooth |
5,848 |
1,889 |
$142K |
| D2140 |
|
2,364 |
1,274 |
$126K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,273 |
471 |
$125K |
| D1310 |
|
2,648 |
2,640 |
$120K |
| D9993 |
|
1,757 |
1,757 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,808 |
1,801 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,657 |
3,644 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,529 |
1,508 |
$60K |
| D0350 |
|
2,670 |
2,341 |
$53K |
| D1110 |
Prophylaxis - adult |
618 |
613 |
$51K |
| D9430 |
|
1,467 |
1,292 |
$46K |
| D2160 |
|
530 |
323 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,222 |
3,038 |
$38K |
| D0603 |
|
2,197 |
2,189 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,724 |
2,717 |
$31K |
| D4341 |
|
397 |
103 |
$28K |
| D2330 |
|
345 |
214 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
192 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
51 |
39 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
344 |
344 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
38 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
187 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
417 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
62 |
28 |
$14K |
| D4910 |
|
157 |
157 |
$12K |
| D8670 |
Periodic orthodontic treatment visit |
39 |
39 |
$11K |
| D0330 |
Panoramic radiographic image |
315 |
314 |
$9K |
| D2954 |
|
68 |
57 |
$7K |
| D0602 |
|
342 |
342 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |
| D0601 |
|
36 |
36 |
$540.00 |