| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,498 |
9,468 |
$504K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93,357 |
14,900 |
$373K |
| D1120 |
Prophylaxis - child |
8,626 |
8,589 |
$326K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,626 |
4,607 |
$287K |
| D2740 |
Crown - porcelain/ceramic |
549 |
371 |
$261K |
| D1351 |
Sealant - per tooth |
8,306 |
2,499 |
$224K |
| D0274 |
Bitewings - four radiographic images |
8,867 |
8,834 |
$190K |
| D1206 |
Topical application of fluoride varnish |
10,497 |
10,458 |
$132K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,739 |
1,141 |
$116K |
| D1110 |
Prophylaxis - adult |
1,120 |
1,111 |
$96K |
| D0350 |
|
9,388 |
3,549 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,334 |
788 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,077 |
729 |
$72K |
| D4341 |
|
816 |
348 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
481 |
282 |
$56K |
| D2140 |
|
930 |
589 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,891 |
3,877 |
$44K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
72 |
68 |
$32K |
| D0330 |
Panoramic radiographic image |
920 |
914 |
$27K |
| D9430 |
|
760 |
753 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,321 |
1,310 |
$15K |
| D4910 |
|
194 |
194 |
$15K |
| D2954 |
|
128 |
100 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
15 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
66 |
$5K |
| D2160 |
|
26 |
24 |
$2K |