| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,127 |
24,053 |
$1.32M |
| D1120 |
Prophylaxis - child |
28,450 |
28,368 |
$1.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,742 |
1,908 |
$676K |
| D0230 |
Intraoral - periapical each additional radiographic image |
146,637 |
27,144 |
$587K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,645 |
4,182 |
$580K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,123 |
1,748 |
$508K |
| D2140 |
|
7,790 |
3,520 |
$424K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,859 |
3,590 |
$393K |
| D1310 |
|
6,809 |
6,783 |
$312K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,598 |
24,532 |
$301K |
| D1351 |
Sealant - per tooth |
10,460 |
3,380 |
$289K |
| D9993 |
|
3,635 |
3,635 |
$235K |
| D0272 |
Bitewings - two radiographic images |
13,417 |
13,396 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
10,439 |
10,347 |
$123K |
| D0350 |
|
10,849 |
4,920 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,418 |
4,405 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,426 |
1,421 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,637 |
3,628 |
$81K |
| D0603 |
|
5,207 |
5,182 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,134 |
1,130 |
$64K |
| D2330 |
|
586 |
306 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
304 |
107 |
$17K |
| D0602 |
|
911 |
911 |
$14K |
| D1320 |
|
1,239 |
1,235 |
$12K |
| D2160 |
|
132 |
94 |
$11K |
| D1510 |
|
69 |
61 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
36 |
$4K |
| D0601 |
|
14 |
14 |
$210.00 |