| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,214 |
6,177 |
$554K |
| D1351 |
Sealant - per tooth |
3,661 |
843 |
$137K |
| D1120 |
Prophylaxis - child |
6,315 |
6,266 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
726 |
124 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
746 |
733 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,244 |
4,199 |
$56K |
| D1206 |
Topical application of fluoride varnish |
6,246 |
6,193 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,782 |
4,714 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
116 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
325 |
146 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,453 |
4,332 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
112 |
$18K |
| D2140 |
|
146 |
76 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
195 |
194 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
29 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
19 |
$1K |