| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,711 |
2,704 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,627 |
921 |
$105K |
| D1120 |
Prophylaxis - child |
2,829 |
2,820 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,695 |
3,525 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
747 |
738 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,042 |
2,036 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,261 |
3,251 |
$37K |
| D2140 |
|
675 |
380 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
808 |
799 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
844 |
741 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
622 |
313 |
$32K |
| D0350 |
|
3,549 |
1,433 |
$30K |
| D2160 |
|
367 |
238 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,319 |
1,230 |
$15K |
| D1351 |
Sealant - per tooth |
517 |
191 |
$14K |
| D2335 |
|
73 |
41 |
$9K |
| D4910 |
|
98 |
98 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
14 |
$7K |
| D9110 |
|
103 |
80 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
57 |
$6K |
| D1110 |
Prophylaxis - adult |
49 |
49 |
$4K |
| D9430 |
|
126 |
123 |
$4K |
| D4341 |
|
46 |
12 |
$3K |
| D1310 |
|
67 |
67 |
$3K |
| D1999 |
|
1,576 |
1,527 |
$3K |
| D9993 |
|
41 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
98 |
94 |
$1K |
| D0603 |
|
56 |
56 |
$795.00 |