| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,845 |
5,797 |
$343K |
| D1120 |
Prophylaxis - child |
5,729 |
5,668 |
$227K |
| D1110 |
Prophylaxis - adult |
2,159 |
2,144 |
$187K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
2,366 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,061 |
7,473 |
$145K |
| D1206 |
Topical application of fluoride varnish |
8,179 |
8,103 |
$115K |
| D1351 |
Sealant - per tooth |
3,568 |
959 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,251 |
752 |
$83K |
| D2140 |
|
1,420 |
759 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,354 |
4,299 |
$51K |
| D9430 |
|
1,578 |
1,324 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,381 |
3,350 |
$40K |
| D1310 |
|
931 |
921 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
573 |
336 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
589 |
586 |
$27K |
| D9993 |
|
498 |
497 |
$26K |
| D1320 |
|
1,373 |
1,354 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
30 |
27 |
$14K |
| D0601 |
|
750 |
742 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
66 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$185.50 |
| D1999 |
|
275 |
273 |
$66.00 |