| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,773 |
22,692 |
$1.27M |
| D1120 |
Prophylaxis - child |
27,182 |
27,087 |
$1.07M |
| D0230 |
Intraoral - periapical each additional radiographic image |
122,189 |
25,882 |
$492K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,249 |
3,952 |
$417K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,311 |
27,218 |
$381K |
| D1310 |
|
4,999 |
4,976 |
$228K |
| D0272 |
Bitewings - two radiographic images |
18,495 |
18,432 |
$218K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,701 |
2,696 |
$172K |
| D1351 |
Sealant - per tooth |
6,169 |
1,858 |
$165K |
| D2140 |
|
2,361 |
1,746 |
$127K |
| D9993 |
|
1,917 |
1,915 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
9,752 |
9,612 |
$115K |
| D9248 |
|
2,969 |
2,903 |
$103K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,288 |
1,288 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
622 |
500 |
$72K |
| D0350 |
|
6,509 |
4,334 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
634 |
500 |
$62K |
| D0603 |
|
3,879 |
3,858 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
831 |
577 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
634 |
476 |
$43K |
| D9430 |
|
1,325 |
1,314 |
$42K |
| D2160 |
|
263 |
235 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
157 |
$12K |
| D2330 |
|
132 |
91 |
$10K |
| D0602 |
|
216 |
216 |
$3K |
| D0601 |
|
177 |
177 |
$3K |
| D2331 |
|
13 |
12 |
$1K |