| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,693 |
11,654 |
$661K |
| D1110 |
Prophylaxis - adult |
5,153 |
5,134 |
$437K |
| D0350 |
|
45,272 |
11,344 |
$434K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,472 |
1,972 |
$410K |
| D1120 |
Prophylaxis - child |
10,464 |
10,428 |
$398K |
| D1351 |
Sealant - per tooth |
13,788 |
3,693 |
$390K |
| D2740 |
Crown - porcelain/ceramic |
814 |
592 |
$387K |
| D4341 |
|
5,731 |
1,607 |
$387K |
| D4910 |
|
4,341 |
4,323 |
$333K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,050 |
2,356 |
$288K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,112 |
4,092 |
$260K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,660 |
11,361 |
$231K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,254 |
1,604 |
$216K |
| D0210 |
Intraoral - complete series of radiographic images |
4,526 |
4,505 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,108 |
1,664 |
$208K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,615 |
15,563 |
$199K |
| D9110 |
|
3,126 |
3,058 |
$196K |
| D2160 |
|
1,775 |
1,145 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,633 |
944 |
$89K |
| D0272 |
Bitewings - two radiographic images |
7,068 |
7,046 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
984 |
724 |
$78K |
| D4342 |
|
1,832 |
639 |
$75K |
| D0330 |
Panoramic radiographic image |
2,301 |
2,284 |
$68K |
| D2954 |
|
633 |
480 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,687 |
4,563 |
$55K |
| D1320 |
|
3,160 |
3,158 |
$47K |
| D2330 |
|
579 |
296 |
$45K |
| D1310 |
|
972 |
967 |
$44K |
| D9993 |
|
668 |
667 |
$43K |
| D2140 |
|
459 |
285 |
$25K |
| D5650 |
|
308 |
125 |
$24K |
| D2332 |
|
181 |
105 |
$15K |
| D0601 |
|
912 |
907 |
$14K |
| D0274 |
Bitewings - four radiographic images |
557 |
557 |
$12K |
| D2335 |
|
64 |
42 |
$7K |
| D5741 |
|
74 |
73 |
$7K |
| D3320 |
|
19 |
15 |
$7K |
| D5740 |
|
52 |
50 |
$5K |
| D2161 |
|
30 |
24 |
$3K |
| D5640 |
|
34 |
17 |
$2K |