| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
22,390 |
22,306 |
$1.26M |
| D1120 |
Prophylaxis - child |
28,981 |
28,876 |
$1.13M |
| D0230 |
Intraoral - periapical each additional radiographic image |
106,351 |
23,323 |
$421K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,669 |
28,566 |
$325K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,701 |
3,692 |
$243K |
| D1351 |
Sealant - per tooth |
7,984 |
1,729 |
$239K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,786 |
2,777 |
$170K |
| D0220 |
Intraoral - periapical first radiographic image |
9,786 |
9,707 |
$115K |
| D0274 |
Bitewings - four radiographic images |
5,257 |
5,247 |
$113K |
| D0272 |
Bitewings - two radiographic images |
9,534 |
9,495 |
$112K |
| D1310 |
|
2,253 |
2,251 |
$102K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,310 |
635 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,198 |
845 |
$68K |
| D9430 |
|
587 |
575 |
$18K |
| D0601 |
|
891 |
891 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
102 |
75 |
$12K |
| D0603 |
|
694 |
694 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
60 |
$8K |
| D2140 |
|
134 |
93 |
$7K |
| D0602 |
|
384 |
384 |
$6K |
| D0350 |
|
317 |
201 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D1203 |
|
12 |
12 |
$0.00 |