| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,458 |
5,408 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,618 |
2,027 |
$308K |
| D1120 |
Prophylaxis - child |
5,017 |
4,968 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,329 |
1,557 |
$179K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,696 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,388 |
4,829 |
$132K |
| D1351 |
Sealant - per tooth |
4,002 |
1,370 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,394 |
1,389 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,747 |
6,690 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,024 |
640 |
$81K |
| D0272 |
Bitewings - two radiographic images |
4,421 |
4,373 |
$52K |
| D0350 |
|
5,639 |
2,251 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
946 |
945 |
$44K |
| D0330 |
Panoramic radiographic image |
1,123 |
1,121 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
252 |
163 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
61 |
40 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
375 |
195 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
300 |
129 |
$20K |
| D2140 |
|
276 |
94 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
27 |
27 |
$8K |
| D2331 |
|
69 |
41 |
$6K |
| D2330 |
|
58 |
37 |
$4K |
| D4341 |
|
52 |
13 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$240.00 |