| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,194 |
4,177 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
2,511 |
2,501 |
$181K |
| D1110 |
Prophylaxis - adult |
1,559 |
1,553 |
$138K |
| D4910 |
|
1,723 |
1,720 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,878 |
1,878 |
$126K |
| D1310 |
|
2,537 |
2,529 |
$116K |
| D9430 |
|
3,169 |
2,937 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,894 |
5,035 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,205 |
1,204 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,466 |
3,454 |
$57K |
| D1351 |
Sealant - per tooth |
1,569 |
379 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,297 |
2,289 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
949 |
364 |
$52K |
| D9993 |
|
677 |
677 |
$42K |
| D4341 |
|
593 |
159 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,326 |
3,312 |
$38K |
| D0603 |
|
2,522 |
2,512 |
$37K |
| D0350 |
|
3,148 |
1,090 |
$34K |
| D1320 |
|
2,313 |
2,306 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
370 |
370 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,045 |
1,912 |
$24K |
| D2330 |
|
239 |
86 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
39 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
41 |
$6K |
| D7111 |
|
90 |
51 |
$5K |
| D2140 |
|
60 |
16 |
$3K |
| D4342 |
|
42 |
12 |
$2K |