| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,343 |
22,299 |
$1.18M |
| D1120 |
Prophylaxis - child |
26,587 |
26,506 |
$919K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,872 |
3,487 |
$808K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,069 |
3,553 |
$694K |
| D1351 |
Sealant - per tooth |
24,994 |
7,093 |
$646K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,528 |
4,134 |
$502K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,620 |
26,529 |
$340K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81,294 |
26,036 |
$327K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,263 |
2,679 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,998 |
2,991 |
$192K |
| D1310 |
|
4,200 |
4,182 |
$186K |
| D0220 |
Intraoral - periapical first radiographic image |
15,039 |
14,606 |
$177K |
| D0272 |
Bitewings - two radiographic images |
14,668 |
14,636 |
$172K |
| D2140 |
|
2,680 |
1,951 |
$145K |
| D1510 |
|
911 |
812 |
$120K |
| D9993 |
|
1,716 |
1,715 |
$100K |
| D9430 |
|
2,004 |
1,882 |
$61K |
| D0601 |
|
3,932 |
3,917 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
907 |
907 |
$51K |
| D2160 |
|
131 |
119 |
$10K |
| D0602 |
|
17 |
17 |
$255.00 |
| D0603 |
|
12 |
12 |
$150.00 |