| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,787 |
10,742 |
$598K |
| D1120 |
Prophylaxis - child |
10,674 |
10,633 |
$412K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,578 |
3,128 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,806 |
4,796 |
$301K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71,475 |
13,344 |
$288K |
| D0274 |
Bitewings - four radiographic images |
8,552 |
8,514 |
$179K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,423 |
864 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,549 |
12,501 |
$140K |
| D1110 |
Prophylaxis - adult |
1,350 |
1,345 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,257 |
2,253 |
$105K |
| D1351 |
Sealant - per tooth |
2,540 |
523 |
$81K |
| D9430 |
|
2,572 |
2,529 |
$80K |
| D2140 |
|
1,138 |
810 |
$62K |
| D4910 |
|
731 |
729 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,041 |
4,021 |
$47K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
81 |
68 |
$39K |
| D4341 |
|
544 |
147 |
$38K |
| D2160 |
|
460 |
369 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
622 |
361 |
$35K |
| D1310 |
|
754 |
753 |
$34K |
| D9993 |
|
442 |
442 |
$28K |
| D0350 |
|
2,863 |
1,834 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,873 |
1,866 |
$22K |
| D0601 |
|
214 |
214 |
$3K |
| D0603 |
|
78 |
78 |
$1K |