| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,625 |
19,914 |
$828K |
| D1351 |
Sealant - per tooth |
11,940 |
6,010 |
$675K |
| D0120 |
Periodic oral evaluation - established patient |
24,238 |
23,063 |
$615K |
| D1206 |
Topical application of fluoride varnish |
21,669 |
20,694 |
$543K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,129 |
543 |
$216K |
| D7140 |
Extraction, erupted tooth or exposed root |
875 |
551 |
$61K |
| D2332 |
|
436 |
304 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
680 |
389 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,300 |
1,216 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
189 |
132 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,673 |
1,548 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,040 |
1,753 |
$15K |
| D0274 |
Bitewings - four radiographic images |
858 |
791 |
$14K |
| D2140 |
|
376 |
256 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,212 |
2,043 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
334 |
311 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
77 |
$8K |
| D2335 |
|
74 |
39 |
$6K |
| D1510 |
|
54 |
46 |
$5K |
| D2330 |
|
63 |
35 |
$3K |
| D1110 |
Prophylaxis - adult |
54 |
53 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
102 |
$528.40 |
| D0603 |
|
1,347 |
1,334 |
$0.00 |
| D0601 |
|
11,272 |
10,962 |
$0.00 |
| D0602 |
|
4,207 |
4,109 |
$0.00 |