| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,818 |
16,684 |
$1.67M |
| D1351 |
Sealant - per tooth |
10,461 |
2,168 |
$484K |
| D2140 |
|
7,693 |
2,764 |
$359K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,173 |
2,143 |
$258K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,639 |
2,321 |
$216K |
| D0220 |
Intraoral - periapical first radiographic image |
4,400 |
4,272 |
$194K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,370 |
993 |
$146K |
| D0272 |
Bitewings - two radiographic images |
11,648 |
11,522 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
1,673 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,479 |
1,425 |
$83K |
| D1120 |
Prophylaxis - child |
17,732 |
17,581 |
$75K |
| D9248 |
|
1,133 |
1,108 |
$58K |
| D1206 |
Topical application of fluoride varnish |
16,968 |
16,837 |
$35K |
| D1510 |
|
139 |
105 |
$23K |
| D2330 |
|
379 |
217 |
$23K |
| D2332 |
|
342 |
199 |
$21K |
| D0330 |
Panoramic radiographic image |
2,367 |
2,354 |
$20K |
| D9420 |
|
347 |
335 |
$20K |
| D0274 |
Bitewings - four radiographic images |
3,954 |
3,924 |
$20K |
| D1110 |
Prophylaxis - adult |
1,196 |
1,184 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
947 |
407 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,896 |
2,331 |
$4K |
| D2160 |
|
245 |
183 |
$4K |
| D1515 |
|
13 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,139 |
1,128 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
37 |
$824.31 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$488.58 |
| D7960 |
|
20 |
13 |
$464.94 |