| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4220 |
|
1,432 |
1,338 |
$707K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,043 |
1,006 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,683 |
2,678 |
$200K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,690 |
1,588 |
$194K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
758 |
689 |
$186K |
| D1120 |
Prophylaxis - child |
2,455 |
2,451 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,196 |
3,179 |
$117K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
699 |
632 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
2,671 |
2,636 |
$111K |
| D1351 |
Sealant - per tooth |
769 |
747 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
1,012 |
990 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,728 |
3,689 |
$53K |
| D2140 |
|
514 |
493 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,193 |
1,189 |
$41K |
| D1203 |
|
1,343 |
1,341 |
$26K |
| D4355 |
|
84 |
84 |
$14K |
| D2160 |
|
111 |
107 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
39 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
132 |
$10K |
| D3120 |
|
150 |
144 |
$9K |
| D2950 |
|
41 |
39 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$7K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$5K |
| D0272 |
Bitewings - two radiographic images |
174 |
174 |
$4K |
| D2332 |
|
12 |
12 |
$2K |
| D9310 |
|
12 |
12 |
$780.00 |