| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,246 |
6,234 |
$282K |
| D1120 |
Prophylaxis - child |
6,101 |
6,096 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,098 |
3,092 |
$169K |
| D1110 |
Prophylaxis - adult |
1,557 |
1,552 |
$126K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
844 |
479 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,489 |
1,024 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,728 |
1,089 |
$92K |
| D1351 |
Sealant - per tooth |
3,231 |
765 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,007 |
7,997 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,473 |
7,645 |
$76K |
| D0272 |
Bitewings - two radiographic images |
6,523 |
6,513 |
$74K |
| D8670 |
Periodic orthodontic treatment visit |
249 |
248 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,398 |
1,395 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
450 |
270 |
$30K |
| D0350 |
|
2,028 |
1,308 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
817 |
815 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
90 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
79 |
$7K |
| D2330 |
|
73 |
39 |
$6K |
| D9430 |
|
176 |
175 |
$5K |
| D2140 |
|
79 |
46 |
$4K |
| D2160 |
|
35 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
99 |
98 |
$2K |
| D0274 |
Bitewings - four radiographic images |
75 |
74 |
$1K |