| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,226 |
9,533 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,933 |
11,133 |
$168K |
| D1999 |
|
8,373 |
7,888 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
8,415 |
8,051 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,674 |
5,117 |
$111K |
| D0330 |
Panoramic radiographic image |
3,391 |
3,271 |
$101K |
| D0272 |
Bitewings - two radiographic images |
4,900 |
4,541 |
$69K |
| D1110 |
Prophylaxis - adult |
2,455 |
2,300 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
578 |
423 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
405 |
306 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,206 |
2,220 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,586 |
2,301 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
171 |
110 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
137 |
$7K |
| D2140 |
|
97 |
82 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
70 |
$1K |