| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,795 |
5,626 |
$250K |
| D1110 |
Prophylaxis - adult |
3,653 |
3,558 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,510 |
1,460 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
6,511 |
6,310 |
$104K |
| D1351 |
Sealant - per tooth |
9,784 |
2,142 |
$48K |
| D7111 |
|
748 |
503 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,489 |
9,227 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,299 |
3,063 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
352 |
208 |
$21K |
| D1330 |
|
9,451 |
9,186 |
$17K |
| D0272 |
Bitewings - two radiographic images |
7,928 |
7,706 |
$14K |
| D2140 |
|
307 |
158 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64 |
34 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
211 |
211 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
241 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
80 |
47 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,390 |
1,000 |
$1K |
| D1999 |
|
26 |
26 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
18 |
18 |
$360.00 |