| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,454 |
10,449 |
$546K |
| D1120 |
Prophylaxis - child |
9,923 |
9,913 |
$360K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,832 |
2,444 |
$322K |
| D2140 |
|
4,446 |
2,167 |
$240K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
479 |
335 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,812 |
9,867 |
$217K |
| D0210 |
Intraoral - complete series of radiographic images |
3,795 |
3,786 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,426 |
12,412 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,392 |
2,390 |
$148K |
| D0274 |
Bitewings - four radiographic images |
5,252 |
5,246 |
$108K |
| D1110 |
Prophylaxis - adult |
1,022 |
1,021 |
$90K |
| D1351 |
Sealant - per tooth |
3,313 |
1,279 |
$80K |
| D9430 |
|
2,413 |
2,313 |
$74K |
| D0350 |
|
4,772 |
2,539 |
$46K |
| D0330 |
Panoramic radiographic image |
1,086 |
1,086 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,590 |
2,587 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
216 |
86 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,193 |
2,184 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
226 |
100 |
$22K |
| D4341 |
|
269 |
70 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
27 |
$13K |
| D2954 |
|
113 |
68 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
111 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
70 |
$7K |
| D2160 |
|
58 |
40 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
14 |
$2K |
| D4342 |
|
40 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
19 |
$532.00 |