| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,828 |
3,826 |
$158K |
| D1120 |
Prophylaxis - child |
4,610 |
4,606 |
$138K |
| D1351 |
Sealant - per tooth |
3,937 |
1,120 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,020 |
626 |
$58K |
| D9993 |
|
790 |
789 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
757 |
345 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,848 |
3,845 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,138 |
3,132 |
$36K |
| D1310 |
|
790 |
789 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,824 |
3,838 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
265 |
153 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
429 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,456 |
1,359 |
$17K |
| D1206 |
Topical application of fluoride varnish |
738 |
738 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
167 |
166 |
$9K |
| D2140 |
|
117 |
61 |
$6K |
| D0603 |
|
409 |
409 |
$6K |
| D0602 |
|
304 |
304 |
$5K |
| D2330 |
|
24 |
12 |
$2K |
| D9430 |
|
12 |
12 |
$384.00 |