| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,504 |
8,461 |
$465K |
| D1120 |
Prophylaxis - child |
9,896 |
9,849 |
$382K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,516 |
3,032 |
$298K |
| D9248 |
|
4,043 |
3,847 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,813 |
10,505 |
$133K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,292 |
920 |
$127K |
| D1310 |
|
2,758 |
2,750 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,865 |
1,860 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,124 |
1,364 |
$120K |
| D2160 |
|
1,499 |
1,173 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
960 |
723 |
$112K |
| D0274 |
Bitewings - four radiographic images |
4,495 |
4,470 |
$95K |
| D9993 |
|
1,693 |
1,692 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,880 |
7,843 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,068 |
2,058 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,016 |
3,939 |
$47K |
| D0272 |
Bitewings - two radiographic images |
3,345 |
3,333 |
$39K |
| D2140 |
|
714 |
561 |
$38K |
| D0603 |
|
1,536 |
1,533 |
$23K |
| D1351 |
Sealant - per tooth |
655 |
202 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
372 |
369 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
180 |
$18K |
| D9430 |
|
564 |
535 |
$18K |
| D0601 |
|
1,089 |
1,089 |
$16K |
| D1510 |
|
68 |
65 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
55 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D1999 |
|
4,795 |
4,446 |
$184.50 |