| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,794 |
5,785 |
$282K |
| D1120 |
Prophylaxis - child |
5,548 |
5,541 |
$192K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,210 |
1,296 |
$143K |
| D1110 |
Prophylaxis - adult |
1,600 |
1,596 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,098 |
2,097 |
$129K |
| D1351 |
Sealant - per tooth |
5,112 |
1,524 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,965 |
1,960 |
$91K |
| D9430 |
|
1,787 |
1,724 |
$56K |
| D2140 |
|
1,063 |
722 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,167 |
2,161 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,549 |
4,544 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,130 |
2,128 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,257 |
4,584 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,046 |
2,870 |
$36K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
49 |
43 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
408 |
285 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,775 |
1,774 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
81 |
81 |
$4K |
| D2160 |
|
37 |
27 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$832.65 |