| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,823 |
3,810 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
3,327 |
3,312 |
$156K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,629 |
746 |
$119K |
| D1351 |
Sealant - per tooth |
2,401 |
572 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,506 |
3,482 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,378 |
2,228 |
$43K |
| D1206 |
Topical application of fluoride varnish |
3,985 |
3,966 |
$41K |
| D2140 |
|
547 |
293 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
525 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,860 |
2,806 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
147 |
42 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
93 |
$18K |
| D0330 |
Panoramic radiographic image |
537 |
535 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
140 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
14 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
18 |
$5K |