| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,864 |
12,840 |
$672K |
| D1120 |
Prophylaxis - child |
15,997 |
15,953 |
$575K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,137 |
2,737 |
$409K |
| D2140 |
|
6,476 |
2,891 |
$350K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,920 |
15,971 |
$319K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,190 |
4,182 |
$258K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,423 |
18,367 |
$226K |
| D1351 |
Sealant - per tooth |
8,341 |
2,598 |
$199K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,703 |
1,367 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
12,779 |
12,689 |
$149K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,256 |
461 |
$145K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
238 |
177 |
$113K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,090 |
417 |
$108K |
| D1310 |
|
2,189 |
2,187 |
$96K |
| D1110 |
Prophylaxis - adult |
1,109 |
1,107 |
$91K |
| D9993 |
|
1,379 |
1,378 |
$83K |
| D0350 |
|
5,920 |
3,974 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,297 |
1,296 |
$62K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
81 |
71 |
$38K |
| D2954 |
|
258 |
187 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,872 |
1,867 |
$22K |
| D0603 |
|
1,477 |
1,476 |
$21K |
| D0274 |
Bitewings - four radiographic images |
826 |
826 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
250 |
250 |
$13K |
| D2330 |
|
102 |
58 |
$8K |
| D2160 |
|
93 |
65 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
28 |
$5K |
| D4341 |
|
58 |
15 |
$4K |
| D9430 |
|
107 |
104 |
$3K |
| D0601 |
|
159 |
159 |
$2K |