| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,580 |
13,515 |
$769K |
| D1120 |
Prophylaxis - child |
16,100 |
16,023 |
$634K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,630 |
2,304 |
$310K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,152 |
14,660 |
$307K |
| D1351 |
Sealant - per tooth |
10,019 |
3,152 |
$296K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,471 |
18,398 |
$264K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,908 |
3,898 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,963 |
2,052 |
$225K |
| D1310 |
|
4,512 |
4,490 |
$201K |
| D2140 |
|
3,656 |
1,881 |
$199K |
| D1110 |
Prophylaxis - adult |
1,636 |
1,635 |
$139K |
| D9993 |
|
2,175 |
2,175 |
$139K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
958 |
381 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
9,140 |
9,087 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
2,069 |
2,064 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
810 |
324 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,163 |
6,126 |
$72K |
| D0603 |
|
3,502 |
3,483 |
$51K |
| D0350 |
|
4,854 |
2,625 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
465 |
465 |
$25K |
| D4341 |
|
300 |
78 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
171 |
122 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
112 |
$14K |
| D4910 |
|
65 |
65 |
$5K |
| D0602 |
|
334 |
334 |
$5K |
| D0601 |
|
293 |
293 |
$4K |
| D2160 |
|
26 |
14 |
$2K |
| D9430 |
|
16 |
16 |
$512.00 |