| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
21,715 |
21,633 |
$1.11M |
| D1120 |
Prophylaxis - child |
20,466 |
20,397 |
$726K |
| D1351 |
Sealant - per tooth |
21,774 |
6,138 |
$564K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,172 |
743 |
$550K |
| D1110 |
Prophylaxis - adult |
6,777 |
6,737 |
$549K |
| D4910 |
|
7,060 |
7,021 |
$546K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132,826 |
25,402 |
$530K |
| D4341 |
|
7,386 |
2,023 |
$483K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,717 |
2,677 |
$448K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,291 |
5,263 |
$318K |
| D2140 |
|
4,849 |
2,058 |
$261K |
| D0272 |
Bitewings - two radiographic images |
19,135 |
19,051 |
$222K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,889 |
17,818 |
$172K |
| D2954 |
|
1,617 |
1,144 |
$167K |
| D1206 |
Topical application of fluoride varnish |
9,229 |
9,188 |
$157K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,612 |
1,471 |
$146K |
| D8670 |
Periodic orthodontic treatment visit |
429 |
428 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
6,366 |
6,342 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
591 |
257 |
$68K |
| D9993 |
|
1,032 |
1,031 |
$67K |
| D4342 |
|
1,619 |
538 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
613 |
265 |
$61K |
| D1310 |
|
1,281 |
1,280 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,209 |
1,209 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
249 |
172 |
$29K |
| D2931 |
|
122 |
99 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
27 |
$13K |
| D2160 |
|
96 |
68 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
184 |
$6K |
| D0603 |
|
154 |
154 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
60 |
60 |
$2K |
| D0602 |
|
99 |
98 |
$1K |
| D1352 |
|
218 |
59 |
$1K |
| D0601 |
|
68 |
68 |
$1K |