| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,469 |
8,453 |
$477K |
| D1120 |
Prophylaxis - child |
9,057 |
9,039 |
$363K |
| D1351 |
Sealant - per tooth |
9,194 |
2,726 |
$260K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,864 |
9,339 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,457 |
2,453 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,188 |
9,170 |
$121K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
193 |
155 |
$92K |
| D0274 |
Bitewings - four radiographic images |
4,137 |
4,128 |
$86K |
| D1310 |
|
1,902 |
1,895 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,172 |
614 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,459 |
1,455 |
$66K |
| D7240 |
Removal of impacted tooth - completely bony |
280 |
102 |
$65K |
| D9430 |
|
1,450 |
1,374 |
$46K |
| D4910 |
|
579 |
577 |
$43K |
| D9993 |
|
634 |
634 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
647 |
349 |
$36K |
| D2140 |
|
679 |
379 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,078 |
3,074 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
472 |
226 |
$30K |
| D0350 |
|
2,542 |
1,164 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,740 |
1,718 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
180 |
$17K |
| D0603 |
|
863 |
861 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$13K |
| D0602 |
|
582 |
582 |
$9K |
| D2954 |
|
81 |
66 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
106 |
106 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
16 |
$4K |
| D2160 |
|
43 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
24 |
$2K |
| D0270 |
|
358 |
349 |
$2K |
| D1320 |
|
42 |
42 |
$735.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$222.00 |