| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,291 |
11,239 |
$1.20M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,972 |
1,962 |
$265K |
| D1351 |
Sealant - per tooth |
6,564 |
1,284 |
$189K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,694 |
1,216 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,488 |
406 |
$124K |
| D1120 |
Prophylaxis - child |
12,235 |
12,183 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
749 |
327 |
$63K |
| D0272 |
Bitewings - two radiographic images |
8,317 |
8,281 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
800 |
415 |
$43K |
| D2140 |
|
631 |
379 |
$30K |
| D1206 |
Topical application of fluoride varnish |
12,737 |
12,677 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,950 |
1,910 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
370 |
360 |
$20K |
| D2332 |
|
164 |
84 |
$15K |
| D2160 |
|
216 |
133 |
$13K |
| D0274 |
Bitewings - four radiographic images |
2,441 |
2,428 |
$10K |
| D0330 |
Panoramic radiographic image |
765 |
765 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,271 |
1,216 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
25 |
$3K |
| D1999 |
|
110 |
103 |
$2K |
| D1110 |
Prophylaxis - adult |
690 |
681 |
$1K |