| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26,699 |
26,591 |
$1.45M |
| D1120 |
Prophylaxis - child |
24,637 |
24,498 |
$909K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196,593 |
36,418 |
$800K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,896 |
9,862 |
$591K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,499 |
5,074 |
$502K |
| D0274 |
Bitewings - four radiographic images |
22,959 |
22,829 |
$480K |
| D1110 |
Prophylaxis - adult |
5,647 |
5,620 |
$462K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,510 |
32,318 |
$387K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,790 |
2,547 |
$249K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,771 |
2,307 |
$202K |
| D0350 |
|
20,716 |
7,785 |
$190K |
| D2140 |
|
3,293 |
2,226 |
$179K |
| D1351 |
Sealant - per tooth |
7,256 |
2,011 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
1,926 |
1,922 |
$89K |
| D4341 |
|
1,088 |
489 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
5,433 |
5,376 |
$63K |
| D9430 |
|
1,579 |
1,530 |
$49K |
| D9993 |
|
727 |
727 |
$46K |
| D2160 |
|
532 |
427 |
$42K |
| D1310 |
|
754 |
754 |
$34K |
| D4910 |
|
297 |
297 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
35 |
27 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,409 |
1,405 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
195 |
159 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
30 |
28 |
$14K |
| D2330 |
|
88 |
52 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
54 |
$5K |
| D2954 |
|
43 |
38 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$2K |
| D0603 |
|
95 |
95 |
$1K |
| D4342 |
|
27 |
12 |
$1K |
| D0270 |
|
155 |
154 |
$715.00 |
| D0601 |
|
26 |
26 |
$390.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
21 |
20 |
$95.28 |
| D0999 |
Unspecified diagnostic procedure, by report |
21 |
20 |
$0.00 |