| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,567 |
6,547 |
$354K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,263 |
9,297 |
$220K |
| D1120 |
Prophylaxis - child |
5,786 |
5,767 |
$219K |
| D1110 |
Prophylaxis - adult |
2,307 |
2,302 |
$199K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,774 |
1,601 |
$185K |
| D1351 |
Sealant - per tooth |
6,005 |
1,717 |
$159K |
| D0274 |
Bitewings - four radiographic images |
6,460 |
6,439 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,084 |
8,060 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,540 |
$96K |
| D9430 |
|
1,718 |
1,681 |
$54K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
85 |
65 |
$40K |
| D2140 |
|
697 |
479 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,987 |
2,957 |
$35K |
| D2160 |
|
395 |
287 |
$31K |
| D0350 |
|
3,555 |
1,621 |
$29K |
| D7111 |
|
328 |
197 |
$19K |
| D0330 |
Panoramic radiographic image |
453 |
449 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
16 |
$8K |
| D2330 |
|
35 |
24 |
$3K |
| D2331 |
|
25 |
17 |
$2K |