| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,821 |
8,650 |
$993K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,805 |
984 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,351 |
1,319 |
$165K |
| D2140 |
|
1,781 |
772 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
956 |
343 |
$88K |
| D1120 |
Prophylaxis - child |
8,774 |
8,596 |
$86K |
| D0272 |
Bitewings - two radiographic images |
8,443 |
8,262 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
9,839 |
9,517 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
918 |
$52K |
| D1206 |
Topical application of fluoride varnish |
8,659 |
8,501 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
948 |
73 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,941 |
8,594 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
138 |
$21K |
| D1351 |
Sealant - per tooth |
151 |
63 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
514 |
298 |
$20K |
| D0330 |
Panoramic radiographic image |
1,570 |
1,539 |
$20K |
| D1110 |
Prophylaxis - adult |
730 |
723 |
$12K |
| D0274 |
Bitewings - four radiographic images |
239 |
184 |
$5K |
| D9248 |
|
122 |
121 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
131 |
16 |
$3K |
| D9420 |
|
148 |
77 |
$3K |
| D0350 |
|
135 |
75 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
794 |
776 |
$1K |