| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,469 |
9,420 |
$524K |
| D1120 |
Prophylaxis - child |
9,377 |
9,301 |
$355K |
| D1110 |
Prophylaxis - adult |
3,239 |
3,212 |
$277K |
| D1351 |
Sealant - per tooth |
9,687 |
2,777 |
$254K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,252 |
11,629 |
$239K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,249 |
1,963 |
$217K |
| D2140 |
|
3,692 |
1,927 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,270 |
3,252 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,821 |
1,803 |
$161K |
| D1206 |
Topical application of fluoride varnish |
10,825 |
10,743 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
6,127 |
6,049 |
$72K |
| D0272 |
Bitewings - two radiographic images |
5,774 |
5,721 |
$68K |
| D1310 |
|
1,049 |
1,048 |
$43K |
| D9993 |
|
937 |
935 |
$31K |
| D2160 |
|
375 |
287 |
$30K |
| D9430 |
|
874 |
814 |
$28K |
| D1320 |
|
1,592 |
1,572 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,782 |
1,761 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
26 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
288 |
288 |
$14K |
| D0601 |
|
687 |
683 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
28 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$1K |
| D0603 |
|
15 |
15 |
$165.00 |
| D1999 |
|
361 |
354 |
$30.00 |