| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,113 |
10,073 |
$532K |
| D1120 |
Prophylaxis - child |
9,695 |
9,657 |
$353K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,929 |
11,194 |
$248K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,579 |
1,363 |
$173K |
| D1110 |
Prophylaxis - adult |
2,036 |
2,028 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,115 |
12,069 |
$139K |
| D0272 |
Bitewings - two radiographic images |
9,280 |
9,244 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,751 |
1,743 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,696 |
820 |
$96K |
| D2140 |
|
1,696 |
991 |
$92K |
| D1351 |
Sealant - per tooth |
2,743 |
940 |
$63K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
127 |
78 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,172 |
1,166 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
273 |
$33K |
| D4341 |
|
501 |
138 |
$32K |
| D9430 |
|
695 |
672 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
399 |
220 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
534 |
518 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,412 |
1,374 |
$16K |
| D9993 |
|
319 |
319 |
$12K |
| D0350 |
|
1,255 |
686 |
$12K |
| D1310 |
|
322 |
322 |
$11K |
| D4910 |
|
96 |
96 |
$7K |
| D0274 |
Bitewings - four radiographic images |
335 |
334 |
$7K |
| D2954 |
|
53 |
37 |
$6K |
| D2160 |
|
54 |
37 |
$4K |
| D0603 |
|
106 |
106 |
$1K |
| D1206 |
Topical application of fluoride varnish |
60 |
60 |
$1K |
| D0601 |
|
55 |
55 |
$240.00 |
| D1999 |
|
119 |
116 |
$138.00 |