| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,575 |
13,558 |
$637K |
| D0120 |
Periodic oral evaluation - established patient |
15,549 |
15,530 |
$493K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,774 |
1,722 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,182 |
15,168 |
$232K |
| D1110 |
Prophylaxis - adult |
3,596 |
3,591 |
$226K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,824 |
1,772 |
$215K |
| D1351 |
Sealant - per tooth |
1,316 |
1,288 |
$213K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,664 |
1,621 |
$209K |
| D0220 |
Intraoral - periapical first radiographic image |
11,108 |
11,075 |
$171K |
| D0272 |
Bitewings - two radiographic images |
6,926 |
6,925 |
$129K |
| D0274 |
Bitewings - four radiographic images |
3,084 |
3,084 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,729 |
7,729 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,112 |
2,106 |
$62K |
| D0160 |
|
1,744 |
1,742 |
$55K |
| D2140 |
|
697 |
682 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
521 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
117 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
89 |
$7K |
| D1320 |
|
746 |
745 |
$6K |
| D9110 |
|
74 |
74 |
$2K |
| D9995 |
|
49 |
48 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
35 |
$540.40 |
| D1354 |
|
13 |
12 |
$480.00 |
| D0603 |
|
1,126 |
1,124 |
$0.00 |
| D0602 |
|
2,235 |
2,228 |
$0.00 |
| D0601 |
|
2,276 |
2,273 |
$0.00 |