| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,396 |
7,383 |
$418K |
| D1120 |
Prophylaxis - child |
6,767 |
6,749 |
$255K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,098 |
1,793 |
$206K |
| D1110 |
Prophylaxis - adult |
2,440 |
2,435 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,033 |
8,792 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,041 |
2,038 |
$129K |
| D1206 |
Topical application of fluoride varnish |
9,371 |
9,342 |
$123K |
| D1351 |
Sealant - per tooth |
4,151 |
1,396 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
2,297 |
2,294 |
$104K |
| D0274 |
Bitewings - four radiographic images |
4,939 |
4,925 |
$99K |
| D2160 |
|
1,060 |
748 |
$84K |
| D2740 |
Crown - porcelain/ceramic |
164 |
132 |
$77K |
| D9430 |
|
2,253 |
2,061 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
3,768 |
3,583 |
$44K |
| D0330 |
Panoramic radiographic image |
1,200 |
1,193 |
$33K |
| D1310 |
|
719 |
716 |
$30K |
| D4910 |
|
394 |
389 |
$28K |
| D2140 |
|
469 |
344 |
$25K |
| D9993 |
|
719 |
716 |
$14K |
| D1320 |
|
838 |
830 |
$14K |
| D0272 |
Bitewings - two radiographic images |
973 |
973 |
$11K |
| D0603 |
|
723 |
717 |
$11K |
| D4341 |
|
48 |
12 |
$3K |
| D2330 |
|
15 |
12 |
$1K |
| D0350 |
|
29 |
17 |
$259.20 |