| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,162 |
15,412 |
$1.72M |
| D1351 |
Sealant - per tooth |
14,892 |
2,570 |
$430K |
| D9248 |
|
1,227 |
1,170 |
$273K |
| D1120 |
Prophylaxis - child |
16,435 |
15,514 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,827 |
1,616 |
$157K |
| D0272 |
Bitewings - two radiographic images |
15,395 |
14,573 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,808 |
1,022 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,884 |
616 |
$127K |
| D2140 |
|
2,573 |
812 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,458 |
457 |
$125K |
| D1206 |
Topical application of fluoride varnish |
16,646 |
15,795 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,774 |
1,261 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
16,197 |
15,318 |
$84K |
| D0330 |
Panoramic radiographic image |
3,089 |
2,898 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
213 |
$41K |
| D1110 |
Prophylaxis - adult |
1,067 |
1,045 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
178 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
217 |
73 |
$8K |
| D2332 |
|
43 |
25 |
$2K |
| D2330 |
|
44 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
140 |
$828.00 |
| D1353 |
|
86 |
29 |
$814.80 |
| D1999 |
|
180 |
122 |
$656.62 |
| D2160 |
|
16 |
12 |
$483.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$143.22 |
| D0274 |
Bitewings - four radiographic images |
30 |
28 |
$95.56 |