| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,499 |
17,487 |
$937K |
| D1120 |
Prophylaxis - child |
19,685 |
19,671 |
$723K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129,253 |
18,588 |
$509K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,751 |
19,740 |
$237K |
| D0220 |
Intraoral - periapical first radiographic image |
17,779 |
17,767 |
$207K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,125 |
2,088 |
$206K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,866 |
1,702 |
$162K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,140 |
718 |
$132K |
| D2140 |
|
1,934 |
1,321 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,545 |
1,543 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,607 |
973 |
$86K |
| D0350 |
|
7,578 |
5,399 |
$73K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
517 |
336 |
$51K |
| D0145 |
Oral evaluation for a patient under three years of age |
856 |
854 |
$45K |
| D2330 |
|
522 |
325 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
472 |
340 |
$30K |
| D9430 |
|
911 |
900 |
$29K |
| D1310 |
|
646 |
646 |
$24K |
| D0272 |
Bitewings - two radiographic images |
534 |
532 |
$6K |
| D0601 |
|
287 |
287 |
$4K |
| D0603 |
|
190 |
190 |
$3K |
| D1351 |
Sealant - per tooth |
50 |
19 |
$1K |
| D9920 |
|
13 |
13 |
$280.00 |