| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
41,830 |
41,826 |
$1.03M |
| D1120 |
Prophylaxis - child |
24,188 |
24,186 |
$926K |
| D1110 |
Prophylaxis - adult |
16,203 |
16,202 |
$763K |
| D1208 |
Topical application of fluoride, excluding varnish |
40,333 |
40,330 |
$510K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,501 |
3,876 |
$430K |
| D0274 |
Bitewings - four radiographic images |
16,340 |
16,340 |
$398K |
| D0220 |
Intraoral - periapical first radiographic image |
34,388 |
34,384 |
$342K |
| D0272 |
Bitewings - two radiographic images |
20,618 |
20,617 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,097 |
42,041 |
$284K |
| D2160 |
|
2,408 |
1,915 |
$222K |
| D1351 |
Sealant - per tooth |
3,872 |
1,235 |
$190K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
618 |
527 |
$49K |
| D2140 |
|
1,008 |
876 |
$49K |
| D9999 |
Unspecified adjunctive procedure, by report |
185 |
185 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,334 |
1,329 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
206 |
153 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
457 |
$13K |
| D2161 |
|
106 |
96 |
$13K |
| D2335 |
|
91 |
54 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
74 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
50 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
91 |
$5K |
| D1999 |
|
64 |
64 |
$3K |
| D0601 |
|
2,231 |
2,231 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
27 |
$2K |
| D0602 |
|
564 |
564 |
$564.00 |
| D0603 |
|
85 |
85 |
$85.00 |