| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,936 |
9,904 |
$540K |
| D1120 |
Prophylaxis - child |
9,161 |
9,125 |
$348K |
| D1110 |
Prophylaxis - adult |
3,034 |
3,023 |
$263K |
| D1351 |
Sealant - per tooth |
6,902 |
1,671 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,189 |
12,140 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,291 |
2,279 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,200 |
9,605 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,470 |
2,457 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,966 |
6,942 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,189 |
720 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,085 |
689 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
795 |
489 |
$43K |
| D1310 |
|
724 |
723 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,481 |
2,462 |
$29K |
| D2140 |
|
529 |
382 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
340 |
$28K |
| D9993 |
|
432 |
432 |
$26K |
| D2160 |
|
281 |
198 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
203 |
$21K |
| D2330 |
|
194 |
127 |
$15K |
| D0274 |
Bitewings - four radiographic images |
402 |
402 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$7K |
| D0601 |
|
230 |
230 |
$3K |
| D1320 |
|
199 |
188 |
$2K |
| D0603 |
|
77 |
77 |
$1K |
| D9430 |
|
13 |
13 |
$416.00 |
| D0602 |
|
13 |
13 |
$195.00 |