| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,683 |
13,658 |
$781K |
| D1110 |
Prophylaxis - adult |
6,176 |
6,162 |
$526K |
| D1120 |
Prophylaxis - child |
11,580 |
11,554 |
$441K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,056 |
4,041 |
$259K |
| D0210 |
Intraoral - complete series of radiographic images |
5,528 |
5,511 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,497 |
18,453 |
$239K |
| D1351 |
Sealant - per tooth |
8,292 |
2,542 |
$222K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,073 |
2,211 |
$200K |
| D4341 |
|
2,759 |
734 |
$190K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,612 |
912 |
$188K |
| D4910 |
|
2,030 |
2,026 |
$155K |
| D0330 |
Panoramic radiographic image |
4,605 |
4,593 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,167 |
1,549 |
$114K |
| D0274 |
Bitewings - four radiographic images |
5,223 |
5,209 |
$106K |
| D2740 |
Crown - porcelain/ceramic |
214 |
190 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,338 |
4,832 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,119 |
754 |
$75K |
| D2330 |
|
760 |
406 |
$58K |
| D2140 |
|
849 |
545 |
$45K |
| D0350 |
|
3,684 |
2,044 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
69 |
67 |
$32K |
| D1310 |
|
581 |
580 |
$26K |
| D9430 |
|
632 |
612 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,704 |
1,676 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,660 |
1,656 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
77 |
$7K |
| D2160 |
|
59 |
53 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
53 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
50 |
$3K |
| D0601 |
|
151 |
151 |
$2K |
| D2954 |
|
14 |
13 |
$1K |
| D0603 |
|
41 |
40 |
$570.00 |
| D0270 |
|
102 |
100 |
$490.00 |