| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,219 |
9,151 |
$514K |
| D1120 |
Prophylaxis - child |
11,807 |
11,705 |
$440K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,821 |
2,573 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,846 |
2,066 |
$152K |
| D1351 |
Sealant - per tooth |
5,296 |
1,834 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,291 |
1,592 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,066 |
796 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,760 |
1,742 |
$113K |
| D1206 |
Topical application of fluoride varnish |
6,240 |
6,153 |
$100K |
| D1310 |
|
3,470 |
3,456 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,753 |
6,441 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,201 |
824 |
$79K |
| D0272 |
Bitewings - two radiographic images |
6,259 |
6,217 |
$73K |
| D2330 |
|
846 |
518 |
$64K |
| D3240 |
|
559 |
442 |
$54K |
| D9993 |
|
3,125 |
3,112 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,293 |
5,279 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,948 |
1,931 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
558 |
553 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
317 |
277 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,146 |
2,078 |
$25K |
| D9430 |
|
737 |
719 |
$23K |
| D0603 |
|
1,132 |
1,124 |
$12K |
| D0330 |
Panoramic radiographic image |
355 |
336 |
$10K |
| D0602 |
|
1,543 |
1,538 |
$10K |
| D2160 |
|
110 |
97 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
155 |
$7K |
| D0601 |
|
481 |
481 |
$3K |