| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,826 |
5,775 |
$324K |
| D1120 |
Prophylaxis - child |
6,495 |
6,434 |
$250K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,087 |
1,457 |
$176K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,212 |
334 |
$138K |
| D1351 |
Sealant - per tooth |
4,046 |
780 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,489 |
6,428 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,402 |
6,343 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,808 |
6,645 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
608 |
163 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
243 |
242 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
68 |
51 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
332 |
$4K |
| D9110 |
|
12 |
12 |
$756.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$392.00 |