| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,597 |
24,594 |
$500K |
| D1110 |
Prophylaxis - adult |
13,578 |
13,576 |
$469K |
| D1120 |
Prophylaxis - child |
10,607 |
10,606 |
$326K |
| D2161 |
|
4,009 |
3,524 |
$307K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,142 |
5,066 |
$302K |
| D0274 |
Bitewings - four radiographic images |
13,834 |
13,834 |
$258K |
| D1351 |
Sealant - per tooth |
4,822 |
2,314 |
$256K |
| D0220 |
Intraoral - periapical first radiographic image |
25,085 |
25,055 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,851 |
3,257 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,575 |
16,574 |
$180K |
| D2160 |
|
2,718 |
2,436 |
$158K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,201 |
1,920 |
$119K |
| D0272 |
Bitewings - two radiographic images |
9,513 |
9,513 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,846 |
23,845 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,266 |
1,935 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,821 |
1,638 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
906 |
845 |
$58K |
| D2335 |
|
557 |
520 |
$46K |
| D2140 |
|
1,164 |
1,085 |
$32K |
| D2331 |
|
463 |
403 |
$26K |
| D2954 |
|
247 |
242 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,190 |
1,189 |
$13K |
| D2332 |
|
118 |
111 |
$7K |
| D2394 |
|
60 |
57 |
$4K |
| D2330 |
|
59 |
49 |
$2K |