| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,806 |
6,551 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
7,105 |
6,827 |
$191K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,113 |
1,621 |
$131K |
| D1351 |
Sealant - per tooth |
1,527 |
1,008 |
$93K |
| D2160 |
|
1,305 |
1,067 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,102 |
2,984 |
$78K |
| D2140 |
|
1,204 |
986 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
701 |
462 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
7,584 |
7,246 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,766 |
1,675 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,895 |
3,750 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
533 |
416 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
592 |
520 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,408 |
7,090 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,196 |
1,103 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
333 |
$16K |
| D4341 |
|
64 |
32 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
424 |
391 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
206 |
181 |
$12K |
| D1110 |
Prophylaxis - adult |
216 |
196 |
$8K |
| D0274 |
Bitewings - four radiographic images |
486 |
424 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
70 |
$7K |
| D2332 |
|
77 |
64 |
$6K |
| D9110 |
|
69 |
66 |
$4K |
| D2330 |
|
53 |
38 |
$3K |
| D2331 |
|
12 |
12 |
$934.20 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$293.40 |