| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,451 |
8,438 |
$464K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
675 |
448 |
$321K |
| D1120 |
Prophylaxis - child |
8,222 |
8,207 |
$304K |
| D1110 |
Prophylaxis - adult |
3,147 |
3,142 |
$264K |
| D1351 |
Sealant - per tooth |
8,364 |
2,624 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,955 |
8,251 |
$174K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,453 |
910 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,477 |
2,473 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
3,291 |
3,286 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,374 |
11,352 |
$140K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
294 |
269 |
$135K |
| D2954 |
|
1,172 |
799 |
$123K |
| D4341 |
|
1,680 |
461 |
$116K |
| D7111 |
|
1,576 |
797 |
$90K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
764 |
279 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
840 |
290 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,269 |
3,266 |
$69K |
| D9430 |
|
2,127 |
2,062 |
$67K |
| D2140 |
|
1,149 |
517 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,170 |
5,073 |
$61K |
| D4910 |
|
775 |
775 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
376 |
232 |
$25K |
| D3320 |
|
53 |
42 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,251 |
1,249 |
$15K |
| D0350 |
|
1,157 |
1,092 |
$10K |
| D2931 |
|
58 |
38 |
$7K |
| D3310 |
|
23 |
14 |
$7K |
| D4342 |
|
119 |
38 |
$5K |
| D1310 |
|
31 |
31 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
40 |
$1K |