| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
45,105 |
44,261 |
$1.05M |
| D1206 |
Topical application of fluoride varnish |
50,546 |
49,643 |
$1.02M |
| D1110 |
Prophylaxis - adult |
23,012 |
22,533 |
$963K |
| D1120 |
Prophylaxis - child |
28,942 |
28,424 |
$954K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,580 |
6,362 |
$626K |
| D0274 |
Bitewings - four radiographic images |
18,643 |
18,255 |
$493K |
| D2140 |
|
6,601 |
5,056 |
$402K |
| D0330 |
Panoramic radiographic image |
8,274 |
8,153 |
$373K |
| D1351 |
Sealant - per tooth |
10,722 |
3,449 |
$330K |
| D9630 |
|
10,902 |
10,637 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,371 |
2,261 |
$204K |
| D0272 |
Bitewings - two radiographic images |
10,088 |
9,904 |
$179K |
| D1354 |
|
17,094 |
2,689 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,028 |
1,622 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
12,495 |
12,136 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,679 |
4,538 |
$133K |
| D2740 |
Crown - porcelain/ceramic |
260 |
172 |
$120K |
| D2160 |
|
1,274 |
1,098 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,596 |
1,005 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,408 |
6,015 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,958 |
1,936 |
$46K |
| D1353 |
|
1,494 |
465 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
86 |
69 |
$36K |
| D2950 |
|
214 |
151 |
$24K |
| D2335 |
|
193 |
114 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
635 |
624 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
299 |
295 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
57 |
$6K |
| D2332 |
|
72 |
52 |
$6K |
| D2331 |
|
62 |
44 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |
| D9986 |
|
2,738 |
2,679 |
$0.00 |