| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,079 |
6,031 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
10,381 |
10,302 |
$294K |
| D1120 |
Prophylaxis - child |
7,431 |
7,338 |
$268K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,485 |
1,466 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
2,854 |
2,832 |
$194K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,826 |
7,765 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,065 |
$100K |
| D1351 |
Sealant - per tooth |
2,771 |
640 |
$90K |
| D0272 |
Bitewings - two radiographic images |
6,828 |
6,650 |
$78K |
| D1206 |
Topical application of fluoride varnish |
2,278 |
2,261 |
$59K |
| D2140 |
|
768 |
539 |
$52K |
| D2160 |
|
360 |
205 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
5,067 |
4,859 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
125 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,513 |
3,660 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
139 |
135 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
261 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
39 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
14 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
25 |
$1K |
| D1999 |
|
33 |
31 |
$110.00 |