| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
29,925 |
8,564 |
$809K |
| D1120 |
Prophylaxis - child |
22,589 |
22,497 |
$750K |
| D0120 |
Periodic oral evaluation - established patient |
20,067 |
19,994 |
$682K |
| D1206 |
Topical application of fluoride varnish |
11,916 |
11,900 |
$400K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,700 |
3,066 |
$243K |
| D0220 |
Intraoral - periapical first radiographic image |
25,042 |
24,472 |
$238K |
| D0274 |
Bitewings - four radiographic images |
10,073 |
10,044 |
$192K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,814 |
1,735 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,633 |
10,556 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,677 |
22,378 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,485 |
959 |
$125K |
| D2140 |
|
2,958 |
2,260 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,664 |
1,702 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,213 |
2,193 |
$90K |
| D0272 |
Bitewings - two radiographic images |
9,492 |
9,445 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
991 |
676 |
$75K |
| D1310 |
|
5,050 |
5,024 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,096 |
1,088 |
$24K |
| D2332 |
|
332 |
198 |
$22K |
| D0999 |
Unspecified diagnostic procedure, by report |
366 |
366 |
$22K |
| D1999 |
|
455 |
455 |
$18K |
| D0350 |
|
3,267 |
3,198 |
$16K |
| D9430 |
|
644 |
618 |
$13K |
| D0601 |
|
3,094 |
3,090 |
$11K |
| D0603 |
|
2,972 |
2,956 |
$9K |
| D1320 |
|
768 |
768 |
$6K |
| D0602 |
|
1,793 |
1,786 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
115 |
$5K |
| D7111 |
|
41 |
25 |
$2K |
| D2160 |
|
14 |
12 |
$1K |
| D2920 |
|
29 |
26 |
$870.00 |
| D9987 |
|
363 |
362 |
$0.00 |
| D9986 |
|
1,343 |
1,329 |
$0.00 |
| D9993 |
|
3,465 |
3,443 |
$0.00 |