| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,894 |
2,081 |
$448K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,265 |
1,414 |
$371K |
| D1120 |
Prophylaxis - child |
8,682 |
7,976 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,762 |
12,702 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
12,293 |
11,354 |
$241K |
| D1110 |
Prophylaxis - adult |
5,467 |
5,105 |
$222K |
| D1351 |
Sealant - per tooth |
8,024 |
1,278 |
$192K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,609 |
776 |
$124K |
| D9920 |
|
3,854 |
2,904 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,009 |
1,354 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,366 |
2,198 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,819 |
3,492 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,773 |
2,533 |
$73K |
| D0330 |
Panoramic radiographic image |
1,760 |
1,570 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,923 |
1,570 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,658 |
2,267 |
$57K |
| D2140 |
|
1,100 |
801 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,306 |
2,812 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
591 |
526 |
$17K |
| D2335 |
|
79 |
52 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
66 |
$4K |
| D2332 |
|
42 |
29 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
61 |
$3K |
| D2160 |
|
75 |
59 |
$578.82 |