| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,479 |
14,443 |
$799K |
| D1120 |
Prophylaxis - child |
16,743 |
16,704 |
$637K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,036 |
3,163 |
$405K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93,261 |
16,601 |
$375K |
| D2140 |
|
3,595 |
2,073 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,960 |
15,919 |
$184K |
| D1351 |
Sealant - per tooth |
5,578 |
1,565 |
$179K |
| D1310 |
|
2,679 |
2,671 |
$121K |
| D0274 |
Bitewings - four radiographic images |
5,686 |
5,677 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,713 |
1,711 |
$105K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
883 |
512 |
$103K |
| D9993 |
|
1,626 |
1,624 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,651 |
1,117 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
839 |
481 |
$83K |
| D0272 |
Bitewings - two radiographic images |
6,882 |
6,871 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
791 |
422 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,257 |
3,237 |
$38K |
| D0603 |
|
2,146 |
2,139 |
$32K |
| D2330 |
|
398 |
238 |
$30K |
| D2160 |
|
355 |
276 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
474 |
474 |
$25K |
| D0350 |
|
2,533 |
1,665 |
$24K |
| D1206 |
Topical application of fluoride varnish |
737 |
734 |
$21K |
| D1320 |
|
1,364 |
1,364 |
$16K |
| D1110 |
Prophylaxis - adult |
185 |
184 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
26 |
$2K |
| D9430 |
|
28 |
28 |
$836.00 |
| D0602 |
|
55 |
55 |
$810.00 |