| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,582 |
18,493 |
$988K |
| D1120 |
Prophylaxis - child |
20,392 |
20,309 |
$754K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,581 |
4,869 |
$552K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113,406 |
23,600 |
$480K |
| D2140 |
|
6,319 |
3,727 |
$331K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,042 |
21,947 |
$271K |
| D1351 |
Sealant - per tooth |
6,385 |
1,492 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,822 |
3,806 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,038 |
2,560 |
$222K |
| D0220 |
Intraoral - periapical first radiographic image |
14,510 |
14,122 |
$165K |
| D0274 |
Bitewings - four radiographic images |
6,527 |
6,472 |
$140K |
| D0350 |
|
11,288 |
5,863 |
$107K |
| D2330 |
|
1,481 |
884 |
$106K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
851 |
458 |
$93K |
| D1110 |
Prophylaxis - adult |
1,038 |
1,027 |
$91K |
| D2160 |
|
1,068 |
826 |
$80K |
| D1310 |
|
1,629 |
1,621 |
$72K |
| D0272 |
Bitewings - two radiographic images |
5,284 |
5,282 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
512 |
292 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
696 |
695 |
$33K |
| D9430 |
|
950 |
926 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
465 |
464 |
$22K |
| D0603 |
|
1,317 |
1,310 |
$19K |
| D4341 |
|
222 |
63 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
79 |
$12K |
| D1320 |
|
853 |
852 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
14 |
$9K |
| D9993 |
|
116 |
116 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
41 |
$3K |
| D2331 |
|
42 |
28 |
$3K |
| D0602 |
|
26 |
26 |
$386.25 |