| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,388 |
2,365 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
6,352 |
6,314 |
$177K |
| D1120 |
Prophylaxis - child |
4,966 |
4,937 |
$177K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,250 |
738 |
$175K |
| D1351 |
Sealant - per tooth |
6,158 |
1,057 |
$163K |
| D1110 |
Prophylaxis - adult |
2,459 |
2,445 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
1,637 |
1,624 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,291 |
7,251 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,306 |
907 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,777 |
2,763 |
$92K |
| D2140 |
|
1,430 |
946 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,267 |
2,257 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
386 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
427 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,101 |
1,081 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
203 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
116 |
$2K |
| D0601 |
|
4,548 |
4,510 |
$0.00 |
| D0603 |
|
2,138 |
2,123 |
$0.00 |
| D0602 |
|
2,773 |
2,745 |
$0.00 |
| D1999 |
|
1,488 |
1,318 |
$0.00 |