| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,479 |
8,428 |
$487K |
| D1120 |
Prophylaxis - child |
8,766 |
8,711 |
$347K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58,672 |
10,400 |
$245K |
| D1351 |
Sealant - per tooth |
7,440 |
2,100 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,162 |
3,149 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,048 |
1,586 |
$198K |
| D2740 |
Crown - porcelain/ceramic |
398 |
279 |
$189K |
| D1110 |
Prophylaxis - adult |
2,042 |
2,033 |
$176K |
| D4910 |
|
2,219 |
2,202 |
$169K |
| D0350 |
|
16,404 |
5,124 |
$153K |
| D0274 |
Bitewings - four radiographic images |
5,454 |
5,421 |
$113K |
| D4341 |
|
1,542 |
430 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,392 |
8,339 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,651 |
1,644 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
657 |
356 |
$77K |
| D1310 |
|
1,049 |
1,047 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,372 |
2,367 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
163 |
56 |
$37K |
| D2140 |
|
624 |
378 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,452 |
2,435 |
$28K |
| D1320 |
|
1,811 |
1,811 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
57 |
51 |
$26K |
| D9993 |
|
416 |
416 |
$25K |
| D2160 |
|
309 |
219 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
37 |
$22K |
| D4342 |
|
263 |
88 |
$11K |
| D0603 |
|
632 |
632 |
$9K |
| D3320 |
|
19 |
15 |
$7K |
| D9910 |
|
107 |
104 |
$6K |
| D0330 |
Panoramic radiographic image |
123 |
123 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
84 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
25 |
$3K |
| D9430 |
|
64 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
149 |
148 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
41 |
$2K |
| D2954 |
|
14 |
12 |
$1K |