| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,608 |
3,593 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
3,393 |
3,379 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,381 |
774 |
$160K |
| D1120 |
Prophylaxis - child |
3,468 |
3,447 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
3,245 |
3,229 |
$146K |
| D1110 |
Prophylaxis - adult |
1,173 |
1,170 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,543 |
4,482 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
965 |
489 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,647 |
4,628 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,956 |
1,948 |
$41K |
| D0350 |
|
3,674 |
1,458 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
63 |
54 |
$30K |
| D1320 |
|
1,686 |
1,683 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
206 |
$26K |
| D9430 |
|
716 |
686 |
$23K |
| D2140 |
|
377 |
174 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
184 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,089 |
1,060 |
$13K |
| D1351 |
Sealant - per tooth |
458 |
108 |
$12K |
| D0330 |
Panoramic radiographic image |
345 |
345 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
39 |
$6K |
| D4341 |
|
81 |
24 |
$6K |
| D2330 |
|
66 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
354 |
354 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
29 |
$4K |
| D2954 |
|
28 |
25 |
$3K |
| D2160 |
|
23 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
87 |
87 |
$922.00 |