| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,334 |
4,161 |
$423K |
| D1999 |
|
28,194 |
21,472 |
$409K |
| D1120 |
Prophylaxis - child |
20,596 |
16,195 |
$400K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,329 |
18,309 |
$331K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,425 |
8,718 |
$233K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,127 |
2,492 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
12,993 |
9,672 |
$194K |
| D1351 |
Sealant - per tooth |
12,495 |
2,072 |
$188K |
| D0272 |
Bitewings - two radiographic images |
8,398 |
6,624 |
$123K |
| D1110 |
Prophylaxis - adult |
2,472 |
1,946 |
$69K |
| D0330 |
Panoramic radiographic image |
1,949 |
1,643 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
715 |
386 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
652 |
367 |
$31K |
| D2140 |
|
802 |
545 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,378 |
1,256 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
672 |
$16K |
| D9420 |
|
81 |
72 |
$16K |
| D2160 |
|
288 |
196 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,596 |
1,259 |
$12K |
| D2330 |
|
104 |
57 |
$4K |