| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,904 |
7,878 |
$456K |
| D1120 |
Prophylaxis - child |
9,230 |
9,197 |
$358K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,199 |
2,436 |
$214K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,537 |
2,083 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,435 |
2,193 |
$197K |
| D1351 |
Sealant - per tooth |
6,063 |
1,867 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,645 |
9,610 |
$127K |
| D0274 |
Bitewings - four radiographic images |
5,126 |
5,106 |
$109K |
| D1310 |
|
2,204 |
2,196 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,042 |
9,501 |
$80K |
| D9993 |
|
1,186 |
1,186 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,867 |
4,594 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,489 |
3,481 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
551 |
$35K |
| D0603 |
|
1,693 |
1,687 |
$25K |
| D9430 |
|
658 |
623 |
$21K |
| D2394 |
|
80 |
77 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
43 |
37 |
$4K |
| D2330 |
|
54 |
38 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
31 |
$2K |
| D0601 |
|
98 |
98 |
$1K |