| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,224 |
14,193 |
$761K |
| D1110 |
Prophylaxis - adult |
7,075 |
7,049 |
$596K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,079 |
1,015 |
$498K |
| D1120 |
Prophylaxis - child |
13,439 |
13,391 |
$492K |
| D1351 |
Sealant - per tooth |
18,403 |
4,047 |
$452K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,357 |
6,345 |
$397K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,262 |
2,343 |
$384K |
| D0210 |
Intraoral - complete series of radiographic images |
7,974 |
7,951 |
$374K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,810 |
3,250 |
$319K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,311 |
2,878 |
$303K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,562 |
20,485 |
$248K |
| D0274 |
Bitewings - four radiographic images |
7,826 |
7,807 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,205 |
16,057 |
$151K |
| D2140 |
|
2,384 |
1,635 |
$128K |
| D2740 |
Crown - porcelain/ceramic |
197 |
160 |
$94K |
| D3320 |
|
213 |
193 |
$78K |
| D9430 |
|
2,476 |
2,402 |
$77K |
| D2160 |
|
933 |
788 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,903 |
5,771 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,695 |
5,682 |
$67K |
| D0350 |
|
5,195 |
3,162 |
$47K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
86 |
65 |
$40K |
| D9993 |
|
560 |
560 |
$31K |
| D1310 |
|
651 |
651 |
$28K |
| D2954 |
|
151 |
123 |
$16K |
| D4341 |
|
209 |
64 |
$13K |
| D3310 |
|
38 |
24 |
$11K |
| D0601 |
|
622 |
622 |
$9K |
| D2330 |
|
98 |
56 |
$7K |
| D2931 |
|
28 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
38 |
$1K |