| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,977 |
11,906 |
$615K |
| D1120 |
Prophylaxis - child |
12,980 |
12,903 |
$480K |
| D2140 |
|
5,997 |
2,907 |
$312K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,804 |
2,670 |
$309K |
| D1351 |
Sealant - per tooth |
9,498 |
3,355 |
$249K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,711 |
3,683 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,936 |
15,840 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,730 |
12,896 |
$164K |
| D0274 |
Bitewings - four radiographic images |
7,770 |
7,729 |
$162K |
| D1110 |
Prophylaxis - adult |
2,045 |
2,032 |
$158K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
275 |
212 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,951 |
1,256 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
2,160 |
2,156 |
$96K |
| D2160 |
|
1,157 |
746 |
$89K |
| D0350 |
|
8,616 |
4,446 |
$85K |
| D1310 |
|
1,284 |
1,277 |
$58K |
| D4341 |
|
814 |
223 |
$53K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
473 |
203 |
$44K |
| D9993 |
|
668 |
665 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
761 |
387 |
$38K |
| D2952 |
|
262 |
205 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,252 |
2,245 |
$26K |
| D9430 |
|
657 |
649 |
$20K |
| D0601 |
|
1,289 |
1,281 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,202 |
1,195 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
38 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |