| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,100 |
7,091 |
$384K |
| D1120 |
Prophylaxis - child |
6,490 |
6,473 |
$241K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,927 |
8,817 |
$189K |
| D1351 |
Sealant - per tooth |
4,394 |
946 |
$113K |
| D0272 |
Bitewings - two radiographic images |
6,867 |
6,858 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,367 |
7,339 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,209 |
1,206 |
$74K |
| D4341 |
|
698 |
188 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
815 |
811 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
72 |
50 |
$34K |
| D1110 |
Prophylaxis - adult |
348 |
348 |
$31K |
| D9430 |
|
709 |
699 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,776 |
1,757 |
$21K |
| D9993 |
|
226 |
226 |
$14K |
| D1310 |
|
323 |
321 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
152 |
87 |
$10K |
| D1320 |
|
813 |
812 |
$10K |
| D2140 |
|
131 |
69 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
24 |
$4K |
| D4342 |
|
35 |
12 |
$1K |
| D0602 |
|
48 |
46 |
$718.00 |
| D1330 |
|
103 |
103 |
$0.00 |