| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,969 |
7,902 |
$398K |
| D1120 |
Prophylaxis - child |
7,260 |
7,215 |
$268K |
| D1110 |
Prophylaxis - adult |
2,483 |
2,467 |
$209K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,810 |
8,914 |
$207K |
| D1351 |
Sealant - per tooth |
7,274 |
1,731 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,192 |
2,183 |
$135K |
| D0274 |
Bitewings - four radiographic images |
6,395 |
6,353 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,337 |
1,280 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,743 |
9,677 |
$120K |
| D4341 |
|
1,406 |
524 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,430 |
954 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,019 |
2,009 |
$94K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
157 |
95 |
$75K |
| D2161 |
|
819 |
605 |
$69K |
| D2160 |
|
638 |
497 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
410 |
223 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,113 |
2,104 |
$25K |
| D2332 |
|
51 |
25 |
$4K |
| D2335 |
|
31 |
15 |
$4K |
| D4342 |
|
62 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
160 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
42 |
$1K |
| D9430 |
|
18 |
18 |
$576.00 |