| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,832 |
6,827 |
$391K |
| D1120 |
Prophylaxis - child |
6,517 |
6,502 |
$249K |
| D1110 |
Prophylaxis - adult |
2,483 |
2,481 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,522 |
6,657 |
$150K |
| D1206 |
Topical application of fluoride varnish |
9,015 |
8,999 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,349 |
2,347 |
$110K |
| D1351 |
Sealant - per tooth |
3,861 |
1,422 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,088 |
627 |
$73K |
| D2140 |
|
1,275 |
535 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,784 |
5,778 |
$68K |
| D7111 |
|
1,026 |
474 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
796 |
796 |
$50K |
| D4910 |
|
566 |
565 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,590 |
2,512 |
$31K |
| D9430 |
|
852 |
819 |
$27K |
| D4341 |
|
371 |
103 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
40 |
28 |
$19K |
| D0350 |
|
1,691 |
1,518 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
137 |
68 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
104 |
56 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
39 |
$9K |
| D2954 |
|
81 |
52 |
$9K |
| D2330 |
|
72 |
43 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
31 |
$4K |