| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,285 |
20,194 |
$1.17M |
| D1120 |
Prophylaxis - child |
26,094 |
25,981 |
$1.10M |
| D1310 |
|
12,154 |
12,095 |
$555K |
| D1206 |
Topical application of fluoride varnish |
26,032 |
25,918 |
$453K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,596 |
1,769 |
$356K |
| D1351 |
Sealant - per tooth |
10,220 |
2,290 |
$310K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,139 |
2,822 |
$292K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,940 |
1,889 |
$264K |
| D9993 |
|
4,238 |
4,237 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,091 |
3,085 |
$206K |
| D2335 |
|
1,575 |
599 |
$186K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,844 |
2,831 |
$184K |
| D0603 |
|
10,465 |
10,412 |
$156K |
| D0350 |
|
13,219 |
5,451 |
$135K |
| D9430 |
|
3,295 |
3,211 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,172 |
10,840 |
$94K |
| D0272 |
Bitewings - two radiographic images |
7,814 |
7,780 |
$90K |
| D7111 |
|
1,523 |
994 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
6,804 |
6,682 |
$81K |
| D2160 |
|
884 |
584 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
979 |
522 |
$65K |
| D1354 |
|
5,515 |
1,386 |
$65K |
| D0601 |
|
1,516 |
1,513 |
$23K |
| D9920 |
|
111 |
107 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
128 |
$10K |
| D2330 |
|
123 |
65 |
$10K |
| D0274 |
Bitewings - four radiographic images |
362 |
362 |
$8K |
| D2140 |
|
43 |
26 |
$2K |
| D1999 |
|
1,071 |
1,014 |
$300.00 |