| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,547 |
5,533 |
$323K |
| D1120 |
Prophylaxis - child |
4,822 |
4,805 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,631 |
2,620 |
$166K |
| D2740 |
Crown - porcelain/ceramic |
305 |
255 |
$145K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,653 |
$142K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,732 |
7,082 |
$132K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,017 |
997 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
2,478 |
2,462 |
$112K |
| D9430 |
|
3,153 |
3,002 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,488 |
878 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,916 |
3,905 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,129 |
6,108 |
$63K |
| D2140 |
|
912 |
505 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
773 |
491 |
$42K |
| D1320 |
|
2,151 |
2,140 |
$29K |
| D0350 |
|
2,910 |
1,538 |
$28K |
| D1351 |
Sealant - per tooth |
915 |
297 |
$27K |
| D2160 |
|
361 |
222 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
39 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,587 |
1,581 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
136 |
$17K |
| D2954 |
|
141 |
113 |
$15K |
| D4341 |
|
153 |
41 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
54 |
$11K |
| D2330 |
|
121 |
78 |
$9K |
| D0330 |
Panoramic radiographic image |
254 |
254 |
$8K |
| D1206 |
Topical application of fluoride varnish |
403 |
403 |
$6K |
| D0340 |
|
116 |
116 |
$6K |
| D0270 |
|
923 |
906 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
26 |
$3K |
| D3221 |
|
35 |
31 |
$2K |
| D1310 |
|
97 |
97 |
$0.00 |