| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,598 |
1,446 |
$129K |
| D1999 |
|
8,425 |
6,407 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,133 |
6,429 |
$107K |
| D1120 |
Prophylaxis - child |
6,192 |
4,936 |
$107K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,158 |
1,161 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
6,025 |
4,676 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,589 |
2,159 |
$50K |
| D1110 |
Prophylaxis - adult |
1,951 |
1,489 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,752 |
1,280 |
$25K |
| D2140 |
|
799 |
483 |
$25K |
| D0330 |
Panoramic radiographic image |
718 |
392 |
$22K |
| D1351 |
Sealant - per tooth |
931 |
202 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
222 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
201 |
131 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
134 |
$2K |
| D2335 |
|
38 |
12 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
191 |
146 |
$820.29 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$369.80 |