| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
33,521 |
33,306 |
$1.88M |
| D1120 |
Prophylaxis - child |
38,544 |
38,211 |
$1.52M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,144 |
8,444 |
$924K |
| D0230 |
Intraoral - periapical each additional radiographic image |
204,675 |
39,353 |
$896K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,217 |
6,687 |
$885K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,935 |
2,813 |
$823K |
| D2140 |
|
14,735 |
8,073 |
$802K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,915 |
2,807 |
$687K |
| D1208 |
Topical application of fluoride, excluding varnish |
39,955 |
39,607 |
$574K |
| D1351 |
Sealant - per tooth |
19,789 |
8,304 |
$569K |
| D1310 |
|
7,865 |
7,804 |
$359K |
| D0272 |
Bitewings - two radiographic images |
26,126 |
25,970 |
$308K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,941 |
3,933 |
$254K |
| D0220 |
Intraoral - periapical first radiographic image |
15,532 |
15,184 |
$181K |
| D2160 |
|
2,232 |
1,542 |
$178K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,848 |
2,837 |
$169K |
| D0350 |
|
15,940 |
9,293 |
$168K |
| D9993 |
|
2,037 |
2,032 |
$131K |
| D1110 |
Prophylaxis - adult |
1,147 |
1,141 |
$99K |
| D2330 |
|
1,261 |
820 |
$97K |
| D0603 |
|
6,172 |
6,120 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
873 |
871 |
$40K |
| D2331 |
|
277 |
180 |
$22K |
| D1510 |
|
161 |
141 |
$21K |
| D0601 |
|
1,373 |
1,368 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
90 |
$9K |
| D9910 |
|
71 |
71 |
$4K |
| D9430 |
|
27 |
27 |
$864.00 |
| D0602 |
|
14 |
14 |
$210.00 |