| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,226 |
26,154 |
$1.43M |
| D1120 |
Prophylaxis - child |
29,196 |
29,118 |
$1.14M |
| D0274 |
Bitewings - four radiographic images |
14,002 |
13,962 |
$297K |
| D1310 |
|
6,215 |
6,196 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,191 |
23,128 |
$251K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,577 |
26,439 |
$204K |
| D9993 |
|
2,970 |
2,967 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,627 |
2,004 |
$150K |
| D1206 |
Topical application of fluoride varnish |
6,151 |
6,135 |
$134K |
| D0272 |
Bitewings - two radiographic images |
9,172 |
9,152 |
$108K |
| D0603 |
|
5,757 |
5,740 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,179 |
985 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,013 |
1,012 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,777 |
3,754 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
572 |
572 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
317 |
237 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
208 |
159 |
$24K |
| D1351 |
Sealant - per tooth |
442 |
74 |
$17K |
| D2140 |
|
170 |
140 |
$9K |
| D0350 |
|
684 |
516 |
$6K |
| D0602 |
|
56 |
56 |
$840.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D1999 |
|
344 |
343 |
$564.00 |