| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,243 |
13,215 |
$631K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,046 |
3,762 |
$540K |
| D1120 |
Prophylaxis - child |
14,349 |
14,290 |
$468K |
| D2140 |
|
8,095 |
4,117 |
$441K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67,704 |
15,709 |
$396K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,007 |
1,127 |
$353K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,924 |
3,161 |
$339K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,003 |
1,131 |
$298K |
| D1351 |
Sealant - per tooth |
8,082 |
3,135 |
$189K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,872 |
15,807 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,744 |
2,743 |
$170K |
| D2160 |
|
1,878 |
1,256 |
$150K |
| D1110 |
Prophylaxis - adult |
1,688 |
1,684 |
$140K |
| D0272 |
Bitewings - two radiographic images |
11,375 |
11,342 |
$134K |
| D2330 |
|
1,393 |
860 |
$107K |
| D0350 |
|
7,836 |
4,749 |
$89K |
| D1310 |
|
1,334 |
1,332 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,148 |
5,078 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,174 |
1,173 |
$55K |
| D9993 |
|
767 |
766 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
665 |
665 |
$36K |
| D0603 |
|
1,079 |
1,077 |
$16K |
| D4341 |
|
147 |
38 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
75 |
60 |
$9K |
| D2331 |
|
49 |
37 |
$4K |
| D1510 |
|
18 |
14 |
$2K |
| D9910 |
|
33 |
32 |
$2K |
| D9430 |
|
33 |
33 |
$1K |
| D0602 |
|
65 |
65 |
$930.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
19 |
$665.00 |
| D0601 |
|
16 |
16 |
$240.00 |