| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,505 |
7,491 |
$411K |
| D1120 |
Prophylaxis - child |
6,983 |
6,966 |
$262K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,319 |
1,334 |
$155K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,719 |
$148K |
| D2140 |
|
2,684 |
1,403 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,198 |
1,292 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,462 |
8,661 |
$93K |
| D0272 |
Bitewings - two radiographic images |
7,554 |
7,538 |
$89K |
| D0350 |
|
8,916 |
3,340 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,136 |
7,117 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,168 |
1,166 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,016 |
522 |
$54K |
| D9430 |
|
1,089 |
1,054 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,590 |
1,590 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,025 |
1,974 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
335 |
219 |
$22K |
| D1351 |
Sealant - per tooth |
985 |
337 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
430 |
427 |
$20K |
| D9993 |
|
309 |
309 |
$18K |
| D1310 |
|
342 |
342 |
$16K |
| D1320 |
|
719 |
719 |
$10K |
| D4341 |
|
109 |
29 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
25 |
$6K |
| D2160 |
|
54 |
44 |
$4K |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
12 |
$2K |
| D3221 |
|
30 |
14 |
$2K |
| D2330 |
|
21 |
13 |
$2K |
| D0601 |
|
67 |
66 |
$990.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$677.00 |
| D9248 |
|
13 |
13 |
$455.00 |
| D3110 |
|
322 |
147 |
$0.00 |