| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,591 |
2,535 |
$166K |
| D2140 |
|
1,925 |
708 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,690 |
1,685 |
$80K |
| D4341 |
|
897 |
332 |
$62K |
| D1120 |
Prophylaxis - child |
1,310 |
1,303 |
$59K |
| D9430 |
|
1,603 |
1,527 |
$51K |
| D1351 |
Sealant - per tooth |
1,482 |
285 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
340 |
$44K |
| D4910 |
|
560 |
558 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
579 |
576 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
598 |
291 |
$39K |
| D0350 |
|
4,497 |
1,663 |
$37K |
| D1110 |
Prophylaxis - adult |
421 |
417 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,456 |
2,442 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,228 |
1,223 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,065 |
2,110 |
$25K |
| D2160 |
|
69 |
41 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
372 |
$4K |
| D2940 |
|
66 |
52 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
38 |
$3K |
| D2330 |
|
33 |
12 |
$2K |
| D3120 |
|
18 |
13 |
$0.00 |