| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,286 |
13,165 |
$1.27M |
| D1351 |
Sealant - per tooth |
8,757 |
1,865 |
$275K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,901 |
1,846 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,734 |
$207K |
| D1120 |
Prophylaxis - child |
13,092 |
12,969 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
10,779 |
10,574 |
$152K |
| D0272 |
Bitewings - two radiographic images |
7,596 |
7,514 |
$117K |
| D1206 |
Topical application of fluoride varnish |
12,304 |
12,202 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
930 |
566 |
$84K |
| D2140 |
|
1,217 |
703 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,720 |
962 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,332 |
559 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
485 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
876 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,565 |
9,359 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,680 |
1,655 |
$37K |
| D1110 |
Prophylaxis - adult |
864 |
853 |
$31K |
| D0330 |
Panoramic radiographic image |
1,038 |
1,030 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
405 |
401 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,072 |
452 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
46 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
309 |
304 |
$2K |
| D2160 |
|
66 |
46 |
$1K |
| D0270 |
|
111 |
107 |
$880.19 |
| D1999 |
|
38 |
34 |
$372.54 |