| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,428 |
10,370 |
$672K |
| D1110 |
Prophylaxis - adult |
6,276 |
6,240 |
$533K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,641 |
7,612 |
$483K |
| D1120 |
Prophylaxis - child |
11,877 |
11,794 |
$482K |
| D9430 |
|
10,523 |
8,772 |
$322K |
| D1351 |
Sealant - per tooth |
9,446 |
2,077 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,887 |
2,938 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,848 |
1,930 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,812 |
2,026 |
$184K |
| D0274 |
Bitewings - four radiographic images |
7,628 |
7,584 |
$157K |
| D1310 |
|
3,516 |
3,487 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,453 |
10,409 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,030 |
12,917 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
2,127 |
2,112 |
$97K |
| D0330 |
Panoramic radiographic image |
2,844 |
2,836 |
$83K |
| D9993 |
|
1,382 |
1,376 |
$76K |
| D1320 |
|
3,431 |
3,411 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
121 |
95 |
$57K |
| D1206 |
Topical application of fluoride varnish |
3,811 |
3,780 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,608 |
3,538 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
641 |
639 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,207 |
3,192 |
$37K |
| D0603 |
|
2,378 |
2,362 |
$33K |
| D4341 |
|
445 |
165 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
335 |
244 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
132 |
$12K |
| D4910 |
|
151 |
151 |
$12K |
| D2330 |
|
108 |
77 |
$8K |
| D0602 |
|
375 |
373 |
$5K |
| D9110 |
|
324 |
290 |
$5K |
| D0601 |
|
303 |
301 |
$4K |
| D2140 |
|
66 |
42 |
$4K |
| D2331 |
|
32 |
24 |
$2K |
| D1330 |
|
43 |
43 |
$0.00 |