| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,235 |
6,209 |
$336K |
| D1120 |
Prophylaxis - child |
6,753 |
6,729 |
$251K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,056 |
8,146 |
$195K |
| D2140 |
|
3,456 |
1,289 |
$187K |
| D1351 |
Sealant - per tooth |
5,027 |
1,460 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,595 |
1,590 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,733 |
980 |
$99K |
| D1110 |
Prophylaxis - adult |
1,087 |
1,081 |
$92K |
| D0272 |
Bitewings - two radiographic images |
7,654 |
7,628 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,761 |
6,737 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
881 |
465 |
$59K |
| D0350 |
|
3,417 |
1,459 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
29 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
122 |
76 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
97 |
63 |
$10K |
| D4341 |
|
66 |
17 |
$5K |
| D2954 |
|
30 |
17 |
$3K |