| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,345 |
4,318 |
$239K |
| D1120 |
Prophylaxis - child |
4,013 |
3,995 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,010 |
1,163 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,734 |
858 |
$99K |
| D2140 |
|
1,684 |
1,077 |
$91K |
| D1351 |
Sealant - per tooth |
2,406 |
805 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,465 |
4,446 |
$51K |
| D1110 |
Prophylaxis - adult |
524 |
521 |
$44K |
| D9110 |
|
608 |
591 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,781 |
1,600 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
335 |
231 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,811 |
1,793 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
26 |
$16K |
| D0330 |
Panoramic radiographic image |
462 |
461 |
$14K |
| D0350 |
|
1,279 |
507 |
$12K |
| D9430 |
|
244 |
236 |
$8K |
| D2330 |
|
84 |
64 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
104 |
$6K |
| D1206 |
Topical application of fluoride varnish |
343 |
340 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
58 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$237.60 |