| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,656 |
4,632 |
$276K |
| D1110 |
Prophylaxis - adult |
2,818 |
2,805 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,056 |
1,255 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,100 |
2,090 |
$131K |
| D1120 |
Prophylaxis - child |
3,241 |
3,220 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,293 |
1,258 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,868 |
4,991 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
2,031 |
2,017 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,834 |
4,801 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,675 |
2,658 |
$56K |
| D9430 |
|
1,510 |
1,431 |
$47K |
| D0350 |
|
4,457 |
2,170 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
271 |
169 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,265 |
1,261 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
960 |
911 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
16 |
$8K |
| D0240 |
|
645 |
353 |
$7K |
| D1351 |
Sealant - per tooth |
218 |
43 |
$5K |
| D9110 |
|
34 |
28 |
$2K |
| D2954 |
|
15 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$364.00 |
| D0270 |
|
14 |
13 |
$70.00 |