| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,083 |
13,064 |
$697K |
| D1120 |
Prophylaxis - child |
11,269 |
11,250 |
$424K |
| D1110 |
Prophylaxis - adult |
3,842 |
3,833 |
$325K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,932 |
18,796 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,121 |
3,112 |
$197K |
| D9430 |
|
6,050 |
5,836 |
$191K |
| D0274 |
Bitewings - four radiographic images |
8,702 |
8,684 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,095 |
1,256 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,662 |
9,644 |
$116K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,343 |
1,088 |
$88K |
| D0272 |
Bitewings - two radiographic images |
6,616 |
6,599 |
$77K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
141 |
108 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,586 |
5,451 |
$65K |
| D1351 |
Sealant - per tooth |
995 |
202 |
$27K |
| D2330 |
|
182 |
127 |
$14K |
| D2140 |
|
136 |
117 |
$7K |
| D2160 |
|
77 |
68 |
$6K |
| D2952 |
|
29 |
24 |
$3K |
| D2940 |
|
54 |
54 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
35 |
$3K |
| D0270 |
|
102 |
100 |
$480.00 |