| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,285 |
6,249 |
$362K |
| D1120 |
Prophylaxis - child |
6,263 |
6,215 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,280 |
3,265 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,957 |
1,952 |
$190K |
| D1110 |
Prophylaxis - adult |
2,282 |
2,265 |
$188K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,430 |
8,540 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,721 |
1,620 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,486 |
1,121 |
$138K |
| D1206 |
Topical application of fluoride varnish |
8,543 |
8,480 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,275 |
2,264 |
$104K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
833 |
532 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,955 |
3,929 |
$82K |
| D1351 |
Sealant - per tooth |
3,132 |
951 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
875 |
581 |
$58K |
| D0350 |
|
4,272 |
2,487 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
418 |
338 |
$32K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
71 |
54 |
$31K |
| D2160 |
|
344 |
264 |
$27K |
| D9430 |
|
493 |
463 |
$16K |
| D2330 |
|
187 |
106 |
$14K |
| D0272 |
Bitewings - two radiographic images |
952 |
946 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
819 |
783 |
$9K |
| D0330 |
Panoramic radiographic image |
290 |
289 |
$8K |
| D2931 |
|
18 |
14 |
$2K |
| D9110 |
|
29 |
26 |
$2K |
| D7111 |
|
24 |
12 |
$1K |
| D1999 |
|
33 |
32 |
$0.00 |