| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
37,845 |
37,011 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
35,586 |
34,764 |
$991K |
| D1351 |
Sealant - per tooth |
15,733 |
8,101 |
$909K |
| D1206 |
Topical application of fluoride varnish |
32,803 |
32,105 |
$851K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,883 |
3,613 |
$303K |
| D2140 |
|
4,136 |
3,232 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,659 |
2,154 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,393 |
4,288 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,089 |
4,888 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,271 |
11,613 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,900 |
4,694 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
14,147 |
13,508 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,779 |
4,607 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
496 |
443 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
541 |
481 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
615 |
$10K |
| D2160 |
|
122 |
108 |
$8K |
| D1110 |
Prophylaxis - adult |
101 |
99 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
72 |
$3K |
| D0603 |
|
2,054 |
2,049 |
$0.00 |
| D0601 |
|
6,071 |
6,031 |
$0.00 |
| D0602 |
|
4,368 |
4,343 |
$0.00 |