| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,627 |
5,613 |
$310K |
| D1120 |
Prophylaxis - child |
5,380 |
5,356 |
$203K |
| D1110 |
Prophylaxis - adult |
1,991 |
1,983 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,442 |
6,484 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,296 |
2,289 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,423 |
1,440 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,665 |
1,036 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,054 |
5,038 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,456 |
1,451 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,313 |
5,291 |
$56K |
| D0350 |
|
4,234 |
2,126 |
$39K |
| D1351 |
Sealant - per tooth |
1,294 |
439 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
370 |
214 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
45 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
26 |
$9K |
| D2140 |
|
129 |
67 |
$7K |
| D0272 |
Bitewings - two radiographic images |
509 |
504 |
$6K |
| D4341 |
|
78 |
28 |
$5K |
| D9430 |
|
127 |
125 |
$4K |
| D2954 |
|
31 |
27 |
$3K |
| D2160 |
|
17 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$1K |
| D1999 |
|
23 |
23 |
$0.00 |