| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,198 |
25,797 |
$1.93M |
| D1120 |
Prophylaxis - child |
29,080 |
28,640 |
$1.51M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,788 |
2,608 |
$1.05M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
11,813 |
5,885 |
$793K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164,049 |
30,751 |
$673K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,516 |
1,941 |
$547K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,773 |
27,327 |
$471K |
| D1351 |
Sealant - per tooth |
10,076 |
3,852 |
$383K |
| D1310 |
|
7,464 |
7,400 |
$337K |
| D0274 |
Bitewings - four radiographic images |
14,610 |
14,386 |
$315K |
| D2140 |
|
5,568 |
3,650 |
$303K |
| D2160 |
|
3,216 |
2,163 |
$256K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,755 |
2,716 |
$192K |
| D2330 |
|
2,316 |
1,296 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,660 |
1,536 |
$153K |
| D9248 |
|
3,979 |
3,940 |
$139K |
| D0272 |
Bitewings - two radiographic images |
10,187 |
10,008 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
8,332 |
8,197 |
$100K |
| D0350 |
|
9,683 |
5,605 |
$97K |
| D0603 |
|
6,039 |
5,984 |
$89K |
| D1320 |
|
7,114 |
7,111 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,019 |
623 |
$68K |
| D0145 |
Oral evaluation for a patient under three years of age |
682 |
678 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,855 |
1,854 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
391 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
346 |
249 |
$28K |
| D1510 |
|
105 |
84 |
$22K |
| D9430 |
|
477 |
474 |
$15K |
| D0602 |
|
587 |
586 |
$9K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |