| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,268 |
15,268 |
$747K |
| D1120 |
Prophylaxis - child |
18,240 |
18,226 |
$611K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87,643 |
16,518 |
$351K |
| D1351 |
Sealant - per tooth |
9,668 |
2,908 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,208 |
18,195 |
$220K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,842 |
1,759 |
$190K |
| D0274 |
Bitewings - four radiographic images |
6,859 |
6,858 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,048 |
2,047 |
$127K |
| D7111 |
|
2,139 |
1,510 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
7,571 |
7,418 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
725 |
507 |
$84K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,014 |
1,014 |
$58K |
| D2140 |
|
1,065 |
710 |
$58K |
| D0350 |
|
4,947 |
2,643 |
$49K |
| D0272 |
Bitewings - two radiographic images |
3,708 |
3,702 |
$43K |
| D1310 |
|
876 |
873 |
$40K |
| D9430 |
|
880 |
859 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
290 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
331 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
241 |
195 |
$24K |
| D0603 |
|
432 |
430 |
$6K |
| D2330 |
|
46 |
28 |
$4K |
| D0602 |
|
232 |
231 |
$3K |
| D1510 |
|
13 |
12 |
$3K |
| D0601 |
|
136 |
136 |
$2K |
| D1354 |
|
186 |
49 |
$2K |