| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,048 |
7,027 |
$357K |
| D0220 |
Intraoral - periapical first radiographic image |
29,029 |
21,878 |
$334K |
| D1120 |
Prophylaxis - child |
5,710 |
5,694 |
$193K |
| D9910 |
|
3,101 |
3,090 |
$177K |
| D2140 |
|
3,253 |
1,747 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,922 |
12,571 |
$165K |
| D0274 |
Bitewings - four radiographic images |
7,504 |
7,469 |
$152K |
| D4910 |
|
2,052 |
2,051 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,994 |
1,253 |
$133K |
| D1110 |
Prophylaxis - adult |
1,449 |
1,435 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,938 |
1,023 |
$109K |
| D9430 |
|
3,229 |
3,195 |
$100K |
| D1351 |
Sealant - per tooth |
3,597 |
1,600 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,724 |
7,689 |
$87K |
| D0350 |
|
4,235 |
2,945 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
918 |
544 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
587 |
578 |
$30K |
| D9110 |
|
411 |
410 |
$25K |
| D2160 |
|
269 |
215 |
$21K |
| D9920 |
|
169 |
131 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,607 |
1,605 |
$18K |
| D3221 |
|
222 |
180 |
$14K |
| D4341 |
|
199 |
61 |
$12K |
| D2330 |
|
132 |
92 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
30 |
$10K |
| D2920 |
|
206 |
202 |
$8K |
| D7510 |
|
39 |
39 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$1K |