| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,787 |
5,770 |
$336K |
| D1110 |
Prophylaxis - adult |
2,492 |
2,474 |
$210K |
| D1120 |
Prophylaxis - child |
5,444 |
5,417 |
$207K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,464 |
5,848 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
2,308 |
2,294 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,953 |
7,911 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,184 |
5,162 |
$61K |
| D1351 |
Sealant - per tooth |
2,223 |
739 |
$55K |
| D9430 |
|
1,296 |
1,213 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
593 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,703 |
1,664 |
$20K |
| D4341 |
|
259 |
69 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
105 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
25 |
$16K |
| D0350 |
|
1,575 |
1,355 |
$14K |
| D2140 |
|
242 |
137 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
167 |
107 |
$11K |
| D4910 |
|
130 |
126 |
$10K |
| D7111 |
|
157 |
90 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
57 |
$9K |
| D2954 |
|
36 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |