| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,651 |
17,578 |
$993K |
| D1120 |
Prophylaxis - child |
19,462 |
19,365 |
$754K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124,252 |
21,021 |
$527K |
| D2140 |
|
9,247 |
4,674 |
$495K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,972 |
4,425 |
$460K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,752 |
4,736 |
$303K |
| D1310 |
|
5,108 |
5,063 |
$231K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,145 |
2,667 |
$222K |
| D2330 |
|
2,581 |
1,276 |
$196K |
| D0350 |
|
16,490 |
8,266 |
$188K |
| D0272 |
Bitewings - two radiographic images |
15,244 |
15,193 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,655 |
14,590 |
$171K |
| D9993 |
|
2,594 |
2,585 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
3,025 |
3,016 |
$143K |
| D1110 |
Prophylaxis - adult |
1,621 |
1,617 |
$137K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,106 |
836 |
$129K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,199 |
871 |
$118K |
| D1354 |
|
6,905 |
2,290 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
9,007 |
8,709 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,684 |
1,223 |
$96K |
| D1206 |
Topical application of fluoride varnish |
4,717 |
4,686 |
$89K |
| D2160 |
|
1,035 |
783 |
$80K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
164 |
138 |
$77K |
| D9248 |
|
1,832 |
1,759 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,071 |
1,065 |
$62K |
| D1351 |
Sealant - per tooth |
2,550 |
844 |
$61K |
| D0603 |
|
4,077 |
4,038 |
$60K |
| D9430 |
|
1,459 |
1,410 |
$46K |
| D4910 |
|
220 |
219 |
$17K |
| D4341 |
|
205 |
80 |
$14K |
| D0601 |
|
728 |
722 |
$11K |
| D2952 |
|
32 |
26 |
$3K |
| D0602 |
|
16 |
16 |
$240.00 |
| D1999 |
|
174 |
171 |
$135.00 |