| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,531 |
4,522 |
$229K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,325 |
1,409 |
$154K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,460 |
6,516 |
$136K |
| D1110 |
Prophylaxis - adult |
1,501 |
1,494 |
$125K |
| D1120 |
Prophylaxis - child |
3,307 |
3,300 |
$119K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
253 |
189 |
$115K |
| D2140 |
|
1,508 |
939 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,078 |
5,063 |
$59K |
| D2160 |
|
601 |
446 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
436 |
435 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,268 |
2,081 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,156 |
2,152 |
$22K |
| D0350 |
|
2,082 |
885 |
$18K |
| D9430 |
|
145 |
136 |
$4K |
| D1351 |
Sealant - per tooth |
173 |
41 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
40 |
$3K |
| D4341 |
|
41 |
18 |
$2K |
| D2954 |
|
19 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D2330 |
|
19 |
12 |
$1K |