| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
37,926 |
37,533 |
$700K |
| D1120 |
Prophylaxis - child |
24,769 |
24,499 |
$691K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,657 |
2,479 |
$687K |
| D1208 |
Topical application of fluoride, excluding varnish |
41,164 |
40,708 |
$602K |
| D1110 |
Prophylaxis - adult |
13,169 |
13,044 |
$470K |
| D1999 |
|
22,216 |
19,820 |
$434K |
| D0330 |
Panoramic radiographic image |
8,270 |
8,162 |
$395K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,282 |
2,223 |
$315K |
| D0272 |
Bitewings - two radiographic images |
16,471 |
16,280 |
$293K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,937 |
2,585 |
$222K |
| D0274 |
Bitewings - four radiographic images |
8,925 |
8,833 |
$208K |
| D2140 |
|
2,484 |
1,500 |
$118K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,297 |
609 |
$103K |
| D2160 |
|
976 |
605 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,935 |
1,898 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,303 |
1,267 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,914 |
2,847 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,131 |
1,117 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
26 |
$304.50 |