| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31,144 |
31,134 |
$1.94M |
| D1120 |
Prophylaxis - child |
44,317 |
44,308 |
$1.85M |
| D0230 |
Intraoral - periapical each additional radiographic image |
362,847 |
53,744 |
$1.47M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,066 |
20,062 |
$1.32M |
| D1351 |
Sealant - per tooth |
37,215 |
12,978 |
$1.03M |
| D1310 |
|
9,974 |
9,965 |
$454K |
| D1208 |
Topical application of fluoride, excluding varnish |
39,356 |
39,350 |
$446K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,778 |
3,681 |
$387K |
| D0272 |
Bitewings - two radiographic images |
27,769 |
27,754 |
$332K |
| D0274 |
Bitewings - four radiographic images |
16,187 |
16,183 |
$329K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,096 |
2,137 |
$208K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,554 |
1,221 |
$154K |
| D9993 |
|
2,650 |
2,645 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
10,510 |
10,372 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,908 |
4,905 |
$123K |
| D0603 |
|
8,123 |
8,118 |
$121K |
| D2160 |
|
920 |
761 |
$73K |
| D0350 |
|
6,627 |
4,466 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
688 |
$63K |
| D2140 |
|
1,146 |
954 |
$62K |
| D9430 |
|
1,649 |
1,637 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
703 |
543 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
684 |
607 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
200 |
169 |
$24K |
| D0601 |
|
1,238 |
1,237 |
$18K |
| D0602 |
|
358 |
358 |
$5K |
| D2330 |
|
64 |
52 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
43 |
$2K |
| D1354 |
|
214 |
58 |
$2K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$1K |