| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,528 |
3,493 |
$124K |
| D1110 |
Prophylaxis - adult |
2,469 |
2,447 |
$118K |
| D0330 |
Panoramic radiographic image |
2,020 |
2,004 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
3,581 |
3,540 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,613 |
4,567 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,733 |
1,693 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,428 |
4,116 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
694 |
440 |
$59K |
| D9920 |
|
445 |
360 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
215 |
110 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
136 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
174 |
96 |
$16K |
| D0274 |
Bitewings - four radiographic images |
396 |
393 |
$11K |
| D2140 |
|
137 |
108 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
153 |
152 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
218 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
67 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |