| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,178 |
13,158 |
$613K |
| D1120 |
Prophylaxis - child |
16,182 |
16,166 |
$522K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,204 |
3,336 |
$481K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,095 |
3,563 |
$404K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,266 |
1,293 |
$383K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,479 |
1,383 |
$343K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,315 |
15,946 |
$334K |
| D2140 |
|
5,524 |
2,827 |
$299K |
| D1351 |
Sealant - per tooth |
10,915 |
3,138 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,442 |
17,424 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,231 |
3,225 |
$199K |
| D9993 |
|
3,368 |
3,368 |
$197K |
| D1310 |
|
3,642 |
3,642 |
$166K |
| D0274 |
Bitewings - four radiographic images |
3,818 |
3,813 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
6,691 |
6,665 |
$79K |
| D8670 |
Periodic orthodontic treatment visit |
246 |
246 |
$65K |
| D0350 |
|
5,587 |
2,970 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,600 |
1,595 |
$63K |
| D1110 |
Prophylaxis - adult |
734 |
734 |
$62K |
| D0272 |
Bitewings - two radiographic images |
5,318 |
5,315 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
390 |
219 |
$46K |
| D0603 |
|
2,655 |
2,655 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
743 |
741 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
585 |
584 |
$34K |
| D2330 |
|
397 |
229 |
$31K |
| D2160 |
|
358 |
249 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
809 |
808 |
$28K |
| D0330 |
Panoramic radiographic image |
758 |
758 |
$22K |
| D1510 |
|
74 |
64 |
$9K |
| D0602 |
|
475 |
475 |
$7K |
| D9430 |
|
208 |
208 |
$7K |
| D4341 |
|
47 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
28 |
$3K |
| D0601 |
|
165 |
165 |
$2K |