| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,949 |
27,815 |
$1.52M |
| D1120 |
Prophylaxis - child |
31,138 |
30,957 |
$1.19M |
| D1351 |
Sealant - per tooth |
26,113 |
6,479 |
$738K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,391 |
6,067 |
$695K |
| D0272 |
Bitewings - two radiographic images |
32,442 |
32,269 |
$382K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,020 |
6,003 |
$372K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,670 |
30,493 |
$368K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81,020 |
39,467 |
$321K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,866 |
1,459 |
$218K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,167 |
1,632 |
$214K |
| D2140 |
|
3,749 |
2,736 |
$203K |
| D2160 |
|
2,138 |
1,652 |
$170K |
| D0220 |
Intraoral - periapical first radiographic image |
11,924 |
10,230 |
$140K |
| D1110 |
Prophylaxis - adult |
1,527 |
1,526 |
$130K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,557 |
1,548 |
$90K |
| D9430 |
|
2,756 |
2,673 |
$87K |
| D2330 |
|
514 |
342 |
$39K |
| D1310 |
|
629 |
628 |
$28K |
| D2335 |
|
91 |
64 |
$11K |
| D1206 |
Topical application of fluoride varnish |
409 |
408 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
73 |
$7K |
| D0601 |
|
444 |
444 |
$6K |
| D2332 |
|
41 |
30 |
$4K |
| D0340 |
|
57 |
57 |
$3K |
| D4341 |
|
39 |
15 |
$3K |
| D2331 |
|
36 |
28 |
$3K |
| D0603 |
|
107 |
106 |
$2K |
| D0270 |
|
67 |
66 |
$335.00 |