| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,111 |
9,977 |
$543K |
| D1120 |
Prophylaxis - child |
9,081 |
8,946 |
$333K |
| D1110 |
Prophylaxis - adult |
3,889 |
3,842 |
$320K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,702 |
1,887 |
$245K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,257 |
9,370 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,812 |
2,771 |
$173K |
| D0210 |
Intraoral - complete series of radiographic images |
3,836 |
3,782 |
$173K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
360 |
230 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,922 |
12,705 |
$155K |
| D0274 |
Bitewings - four radiographic images |
6,157 |
6,077 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,131 |
1,168 |
$120K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,885 |
898 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,436 |
899 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,080 |
1,153 |
$112K |
| D1351 |
Sealant - per tooth |
2,438 |
976 |
$63K |
| D2160 |
|
767 |
500 |
$58K |
| D0350 |
|
5,465 |
2,786 |
$53K |
| D2140 |
|
829 |
433 |
$43K |
| D2952 |
|
299 |
210 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,169 |
2,136 |
$25K |
| D9430 |
|
712 |
688 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,477 |
1,468 |
$17K |
| D1310 |
|
264 |
264 |
$11K |
| D2931 |
|
85 |
70 |
$11K |
| D2330 |
|
133 |
83 |
$10K |
| D9993 |
|
206 |
206 |
$9K |
| D2394 |
|
18 |
14 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0601 |
|
25 |
25 |
$360.00 |
| D0603 |
|
25 |
25 |
$345.00 |