| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,026 |
6,012 |
$330K |
| D2140 |
|
5,710 |
2,456 |
$306K |
| D1120 |
Prophylaxis - child |
5,886 |
5,868 |
$221K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,915 |
1,683 |
$193K |
| D1351 |
Sealant - per tooth |
5,787 |
1,508 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,486 |
6,130 |
$140K |
| D1110 |
Prophylaxis - adult |
1,496 |
1,491 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,012 |
2,009 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
2,645 |
2,639 |
$118K |
| D0350 |
|
3,871 |
3,123 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,215 |
6,199 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,831 |
2,826 |
$59K |
| D2330 |
|
647 |
335 |
$48K |
| D9430 |
|
736 |
694 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,002 |
1,990 |
$23K |
| D2791 |
|
46 |
38 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
203 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
383 |
149 |
$18K |
| D2332 |
|
245 |
147 |
$18K |
| D2954 |
|
140 |
111 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
76 |
$8K |
| D4341 |
|
115 |
30 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
28 |
$5K |
| D3320 |
|
15 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
302 |
302 |
$3K |
| D2160 |
|
28 |
24 |
$2K |
| D0270 |
|
240 |
235 |
$1K |
| D2331 |
|
16 |
12 |
$1K |