| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,865 |
8,829 |
$552K |
| D1120 |
Prophylaxis - child |
9,089 |
9,059 |
$358K |
| D1110 |
Prophylaxis - adult |
3,291 |
3,276 |
$288K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,528 |
13,555 |
$275K |
| D2740 |
Crown - porcelain/ceramic |
551 |
434 |
$261K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,885 |
2,281 |
$260K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,028 |
4,018 |
$252K |
| D1351 |
Sealant - per tooth |
6,777 |
1,858 |
$203K |
| D0220 |
Intraoral - periapical first radiographic image |
16,205 |
15,659 |
$192K |
| D1206 |
Topical application of fluoride varnish |
5,987 |
5,967 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,627 |
1,089 |
$88K |
| D1310 |
|
1,816 |
1,815 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,744 |
6,724 |
$73K |
| D9993 |
|
1,741 |
1,740 |
$72K |
| D4910 |
|
846 |
846 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,377 |
1,149 |
$54K |
| D9430 |
|
1,569 |
1,554 |
$50K |
| D2330 |
|
466 |
241 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
420 |
317 |
$33K |
| D4341 |
|
476 |
125 |
$33K |
| D0603 |
|
1,564 |
1,563 |
$23K |
| D3221 |
|
336 |
239 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
37 |
36 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
143 |
$12K |
| D0350 |
|
792 |
552 |
$8K |
| D7111 |
|
104 |
72 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$752.25 |