| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28,006 |
27,941 |
$1.55M |
| D1120 |
Prophylaxis - child |
30,934 |
30,800 |
$1.19M |
| D1351 |
Sealant - per tooth |
22,229 |
6,889 |
$633K |
| D0230 |
Intraoral - periapical each additional radiographic image |
144,079 |
27,383 |
$606K |
| D1310 |
|
8,672 |
8,655 |
$393K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,947 |
24,821 |
$277K |
| D9993 |
|
6,970 |
6,964 |
$276K |
| D0274 |
Bitewings - four radiographic images |
12,166 |
12,140 |
$257K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,027 |
2,252 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,931 |
2,928 |
$177K |
| D1206 |
Topical application of fluoride varnish |
7,953 |
7,942 |
$168K |
| D1110 |
Prophylaxis - adult |
1,925 |
1,920 |
$153K |
| D0272 |
Bitewings - two radiographic images |
11,324 |
11,257 |
$133K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,003 |
2,000 |
$123K |
| D0603 |
|
7,590 |
7,575 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
5,589 |
5,521 |
$64K |
| D2160 |
|
650 |
558 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,091 |
1,089 |
$48K |
| D9430 |
|
1,487 |
1,467 |
$46K |
| D2140 |
|
458 |
372 |
$24K |
| D2330 |
|
258 |
160 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
158 |
123 |
$16K |
| D0602 |
|
910 |
910 |
$13K |
| D0350 |
|
1,595 |
1,073 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
91 |
77 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
144 |
$10K |
| D1354 |
|
276 |
233 |
$7K |
| D4342 |
|
28 |
15 |
$1K |