| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,023 |
5,007 |
$276K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,616 |
3,607 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,272 |
2,242 |
$215K |
| D1110 |
Prophylaxis - adult |
2,364 |
2,361 |
$193K |
| D1120 |
Prophylaxis - child |
4,156 |
4,134 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,739 |
5,940 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,482 |
1,157 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,491 |
2,482 |
$113K |
| D2330 |
|
1,466 |
697 |
$112K |
| D1351 |
Sealant - per tooth |
3,463 |
1,082 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,512 |
821 |
$84K |
| D2740 |
Crown - porcelain/ceramic |
259 |
157 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,426 |
1,041 |
$76K |
| D9430 |
|
2,059 |
2,012 |
$65K |
| D0274 |
Bitewings - four radiographic images |
3,102 |
3,087 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,894 |
4,871 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,003 |
4,920 |
$58K |
| D1310 |
|
917 |
916 |
$42K |
| D9993 |
|
680 |
680 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,904 |
1,901 |
$33K |
| D2954 |
|
312 |
241 |
$28K |
| D0350 |
|
2,933 |
1,607 |
$27K |
| D2931 |
|
58 |
55 |
$7K |
| D0603 |
|
304 |
304 |
$4K |
| D0602 |
|
94 |
94 |
$1K |
| D2394 |
|
13 |
12 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |