| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,870 |
17,489 |
$1.01M |
| D1120 |
Prophylaxis - child |
19,258 |
18,858 |
$762K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,607 |
4,019 |
$441K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,757 |
4,054 |
$363K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,436 |
20,008 |
$269K |
| D1351 |
Sealant - per tooth |
8,013 |
2,611 |
$233K |
| D0272 |
Bitewings - two radiographic images |
15,362 |
14,985 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,881 |
18,135 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,029 |
2,242 |
$174K |
| D1310 |
|
3,403 |
3,362 |
$156K |
| D0350 |
|
13,391 |
7,366 |
$133K |
| D9993 |
|
1,584 |
1,583 |
$103K |
| D2330 |
|
1,077 |
641 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,179 |
5,826 |
$73K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
599 |
452 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
973 |
965 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
455 |
337 |
$45K |
| D0603 |
|
2,581 |
2,558 |
$38K |
| D2932 |
|
285 |
162 |
$30K |
| D1110 |
Prophylaxis - adult |
245 |
240 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
285 |
179 |
$19K |
| D4910 |
|
212 |
193 |
$16K |
| D9430 |
|
267 |
263 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
191 |
$7K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$2K |
| D2331 |
|
21 |
13 |
$2K |
| D0602 |
|
102 |
89 |
$2K |
| D1510 |
|
15 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0601 |
|
86 |
86 |
$1K |
| D0270 |
|
179 |
175 |
$893.75 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$392.00 |