| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,716 |
3,654 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
3,082 |
3,070 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,109 |
1,095 |
$100K |
| D0272 |
Bitewings - two radiographic images |
3,310 |
3,262 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
879 |
375 |
$45K |
| D0330 |
Panoramic radiographic image |
427 |
418 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,365 |
3,305 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
146 |
$30K |
| D1206 |
Topical application of fluoride varnish |
3,617 |
3,539 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
742 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,795 |
3,710 |
$27K |
| D1351 |
Sealant - per tooth |
576 |
123 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
187 |
$19K |
| D2140 |
|
367 |
173 |
$16K |
| D9420 |
|
29 |
29 |
$15K |
| D0274 |
Bitewings - four radiographic images |
186 |
184 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
64 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
122 |
27 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
12 |
$44.72 |