| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,124 |
7,051 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
3,439 |
3,391 |
$233K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,529 |
1,667 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,056 |
3,041 |
$203K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,102 |
1,538 |
$176K |
| D1310 |
|
3,786 |
3,740 |
$169K |
| D2140 |
|
3,074 |
1,602 |
$166K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,266 |
544 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,233 |
7,157 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,356 |
7,193 |
$147K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,256 |
537 |
$124K |
| D1351 |
Sealant - per tooth |
2,650 |
1,178 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
5,125 |
5,078 |
$60K |
| D2160 |
|
697 |
437 |
$55K |
| D0603 |
|
3,275 |
3,230 |
$48K |
| D0145 |
Oral evaluation for a patient under three years of age |
613 |
608 |
$42K |
| D0350 |
|
3,909 |
1,875 |
$40K |
| D2331 |
|
428 |
284 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,240 |
2,227 |
$27K |
| D2330 |
|
239 |
146 |
$19K |
| D8670 |
Periodic orthodontic treatment visit |
40 |
40 |
$12K |
| D0601 |
|
382 |
380 |
$6K |
| D1510 |
|
24 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
35 |
$1K |