| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2161 |
|
4,132 |
2,470 |
$297K |
| D2160 |
|
3,311 |
2,085 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
7,487 |
7,487 |
$208K |
| D1120 |
Prophylaxis - child |
6,311 |
6,310 |
$181K |
| D2332 |
|
1,663 |
1,192 |
$174K |
| D0272 |
Bitewings - two radiographic images |
4,576 |
4,575 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,438 |
6,436 |
$71K |
| D0330 |
Panoramic radiographic image |
1,328 |
1,326 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,618 |
5,589 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,116 |
2,115 |
$65K |
| D1110 |
Prophylaxis - adult |
1,384 |
1,384 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,418 |
5,388 |
$46K |
| D1351 |
Sealant - per tooth |
1,567 |
416 |
$44K |
| D2335 |
|
413 |
330 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
816 |
510 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,111 |
1,111 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
210 |
175 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
146 |
126 |
$11K |
| D2331 |
|
132 |
100 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
122 |
122 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
40 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$354.48 |