| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,045 |
7,021 |
$413K |
| D4341 |
|
5,951 |
1,857 |
$413K |
| D1110 |
Prophylaxis - adult |
3,897 |
3,882 |
$337K |
| D4910 |
|
3,951 |
3,932 |
$304K |
| D2791 |
|
448 |
377 |
$213K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,495 |
1,981 |
$188K |
| D1120 |
Prophylaxis - child |
4,866 |
4,849 |
$187K |
| D1351 |
Sealant - per tooth |
5,411 |
1,398 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,624 |
8,710 |
$144K |
| D0274 |
Bitewings - four radiographic images |
5,555 |
5,538 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,290 |
8,260 |
$102K |
| D2330 |
|
1,177 |
820 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,534 |
1,078 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,314 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,490 |
1,482 |
$70K |
| D9430 |
|
1,553 |
1,512 |
$49K |
| D4342 |
|
755 |
285 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,531 |
2,463 |
$30K |
| D2952 |
|
257 |
201 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
187 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
197 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,131 |
1,131 |
$13K |
| D1206 |
Topical application of fluoride varnish |
162 |
162 |
$3K |
| D2954 |
|
14 |
14 |
$1K |