| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,199 |
2,571 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
6,356 |
6,340 |
$339K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,075 |
4,058 |
$255K |
| D1120 |
Prophylaxis - child |
6,640 |
6,624 |
$247K |
| D1110 |
Prophylaxis - adult |
2,518 |
2,510 |
$216K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,765 |
1,097 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,166 |
8,585 |
$191K |
| D1351 |
Sealant - per tooth |
6,921 |
1,935 |
$188K |
| D2140 |
|
2,697 |
1,593 |
$146K |
| D1206 |
Topical application of fluoride varnish |
8,927 |
8,894 |
$118K |
| D9430 |
|
3,732 |
3,586 |
$118K |
| D2160 |
|
1,469 |
996 |
$116K |
| D0274 |
Bitewings - four radiographic images |
5,298 |
5,280 |
$111K |
| D4341 |
|
1,421 |
376 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
2,003 |
1,993 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,214 |
745 |
$69K |
| D0350 |
|
5,543 |
2,409 |
$53K |
| D4910 |
|
666 |
663 |
$51K |
| D0330 |
Panoramic radiographic image |
1,462 |
1,459 |
$43K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
69 |
61 |
$33K |
| D1310 |
|
630 |
627 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,358 |
2,301 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,364 |
2,355 |
$27K |
| D9993 |
|
405 |
405 |
$24K |
| D9248 |
|
690 |
625 |
$21K |
| D2330 |
|
141 |
87 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
13 |
$3K |
| D0603 |
|
160 |
160 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$455.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$404.00 |
| D0602 |
|
12 |
12 |
$180.00 |