| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,021 |
5,002 |
$311K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,253 |
1,826 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,597 |
848 |
$187K |
| D1110 |
Prophylaxis - adult |
2,012 |
2,002 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,573 |
2,567 |
$164K |
| D1120 |
Prophylaxis - child |
3,546 |
3,528 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
2,803 |
2,789 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,044 |
5,011 |
$115K |
| D9430 |
|
3,314 |
3,083 |
$105K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
208 |
174 |
$99K |
| D0350 |
|
8,583 |
3,665 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,889 |
5,860 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,513 |
3,504 |
$75K |
| D1351 |
Sealant - per tooth |
1,529 |
439 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,791 |
3,478 |
$45K |
| D0330 |
Panoramic radiographic image |
1,501 |
1,494 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
597 |
347 |
$40K |
| D2160 |
|
489 |
368 |
$39K |
| D4341 |
|
484 |
135 |
$34K |
| D2140 |
|
619 |
418 |
$34K |
| D4910 |
|
367 |
363 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
170 |
$15K |
| D0272 |
Bitewings - two radiographic images |
909 |
899 |
$11K |
| D2330 |
|
21 |
14 |
$2K |