| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,581 |
7,536 |
$335K |
| D1110 |
Prophylaxis - adult |
3,253 |
3,245 |
$263K |
| D2140 |
|
4,200 |
2,332 |
$226K |
| D1120 |
Prophylaxis - child |
5,387 |
5,342 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,103 |
3,087 |
$187K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,571 |
1,813 |
$170K |
| D9430 |
|
4,973 |
4,562 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
2,736 |
2,731 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,003 |
1,238 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,271 |
6,286 |
$112K |
| D0274 |
Bitewings - four radiographic images |
5,023 |
5,013 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,656 |
6,607 |
$77K |
| D0350 |
|
6,962 |
3,659 |
$62K |
| D1351 |
Sealant - per tooth |
2,114 |
737 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
372 |
256 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,768 |
2,693 |
$33K |
| D4341 |
|
492 |
161 |
$32K |
| D1310 |
|
693 |
691 |
$31K |
| D9993 |
|
692 |
690 |
$28K |
| D2160 |
|
296 |
253 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,325 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
157 |
$15K |
| D3221 |
|
219 |
196 |
$13K |
| D2954 |
|
99 |
84 |
$10K |
| D1206 |
Topical application of fluoride varnish |
902 |
898 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
81 |
$7K |
| D2931 |
|
47 |
43 |
$6K |
| D0603 |
|
343 |
343 |
$5K |
| D2330 |
|
50 |
25 |
$4K |
| D2331 |
|
36 |
13 |
$3K |
| D7111 |
|
21 |
14 |
$1K |
| D4910 |
|
15 |
15 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
46 |
45 |
$812.00 |
| D0602 |
|
12 |
12 |
$165.00 |
| D0270 |
|
12 |
12 |
$60.00 |