| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,573 |
7,530 |
$424K |
| D1120 |
Prophylaxis - child |
6,831 |
6,797 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,500 |
2,433 |
$220K |
| D1110 |
Prophylaxis - adult |
2,529 |
2,513 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,172 |
2,009 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,806 |
8,171 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,147 |
2,136 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,637 |
9,577 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
2,449 |
2,437 |
$115K |
| D0274 |
Bitewings - four radiographic images |
4,524 |
4,494 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,147 |
900 |
$86K |
| D9430 |
|
2,023 |
1,902 |
$64K |
| D0350 |
|
5,609 |
3,003 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
866 |
479 |
$47K |
| D1351 |
Sealant - per tooth |
1,469 |
417 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,498 |
2,447 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,454 |
1,443 |
$17K |
| D1310 |
|
336 |
334 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
109 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$7K |
| D2160 |
|
62 |
40 |
$5K |
| D2330 |
|
62 |
42 |
$5K |
| D1320 |
|
108 |
108 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D2954 |
|
13 |
13 |
$1K |
| D0603 |
|
76 |
76 |
$1K |
| D0270 |
|
12 |
12 |
$60.00 |