| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,815 |
8,752 |
$506K |
| D1120 |
Prophylaxis - child |
8,207 |
8,144 |
$317K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,460 |
1,515 |
$219K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,554 |
11,032 |
$143K |
| D0274 |
Bitewings - four radiographic images |
4,946 |
4,924 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,592 |
1,572 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,430 |
7,382 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,074 |
1,882 |
$79K |
| D1351 |
Sealant - per tooth |
2,743 |
736 |
$74K |
| D1110 |
Prophylaxis - adult |
645 |
642 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,721 |
4,403 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,866 |
3,834 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
627 |
379 |
$42K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
87 |
68 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
681 |
403 |
$37K |
| D2140 |
|
686 |
406 |
$34K |
| D4910 |
|
441 |
441 |
$33K |
| D9430 |
|
1,006 |
976 |
$31K |
| D4341 |
|
451 |
143 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
292 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
39 |
27 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
391 |
$18K |
| D0350 |
|
1,564 |
821 |
$15K |
| D2160 |
|
89 |
45 |
$5K |
| D2954 |
|
33 |
30 |
$3K |
| D1310 |
|
65 |
65 |
$3K |
| D2330 |
|
21 |
13 |
$2K |