| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,320 |
10,286 |
$851K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,623 |
2,613 |
$246K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,261 |
1,291 |
$243K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,048 |
1,614 |
$198K |
| D1120 |
Prophylaxis - child |
12,509 |
12,460 |
$190K |
| D0272 |
Bitewings - two radiographic images |
5,559 |
5,522 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,988 |
1,144 |
$115K |
| D2140 |
|
2,188 |
1,193 |
$110K |
| D1206 |
Topical application of fluoride varnish |
12,555 |
12,511 |
$89K |
| D0330 |
Panoramic radiographic image |
965 |
962 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,505 |
757 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,855 |
3,841 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
6,100 |
6,025 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
908 |
889 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,337 |
5,301 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
100 |
$15K |
| D1351 |
Sealant - per tooth |
257 |
79 |
$7K |
| D1110 |
Prophylaxis - adult |
38 |
36 |
$352.42 |