| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,031 |
17,935 |
$854K |
| D0120 |
Periodic oral evaluation - established patient |
9,720 |
9,677 |
$677K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,381 |
1,743 |
$522K |
| D1310 |
|
11,028 |
10,995 |
$495K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,348 |
3,180 |
$493K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,372 |
6,342 |
$434K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,365 |
1,729 |
$431K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92,036 |
18,926 |
$390K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,403 |
18,302 |
$380K |
| D1351 |
Sealant - per tooth |
9,535 |
3,565 |
$321K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,037 |
2,231 |
$231K |
| D2140 |
|
4,053 |
2,187 |
$221K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,858 |
2,845 |
$197K |
| D0603 |
|
8,521 |
8,500 |
$125K |
| D0272 |
Bitewings - two radiographic images |
10,302 |
10,247 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
9,324 |
9,191 |
$111K |
| D9993 |
|
1,620 |
1,619 |
$102K |
| D2160 |
|
1,148 |
747 |
$91K |
| D0350 |
|
6,226 |
3,080 |
$63K |
| D0602 |
|
2,356 |
2,345 |
$35K |
| D1510 |
|
149 |
122 |
$26K |
| D2330 |
|
168 |
113 |
$13K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$2K |
| D0270 |
|
74 |
74 |
$370.00 |