| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,409 |
4,395 |
$265K |
| D1120 |
Prophylaxis - child |
4,185 |
4,170 |
$162K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
294 |
223 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,946 |
5,805 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,754 |
1,753 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,152 |
3,144 |
$64K |
| D1110 |
Prophylaxis - adult |
745 |
743 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,615 |
4,604 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,133 |
1,133 |
$52K |
| D4910 |
|
668 |
661 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
498 |
277 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
463 |
306 |
$30K |
| D1310 |
|
638 |
634 |
$29K |
| D9993 |
|
290 |
290 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,468 |
1,432 |
$17K |
| D9430 |
|
414 |
400 |
$13K |
| D1351 |
Sealant - per tooth |
542 |
115 |
$13K |
| D1206 |
Topical application of fluoride varnish |
583 |
579 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,011 |
1,007 |
$12K |
| D4341 |
|
178 |
51 |
$12K |
| D1320 |
|
697 |
697 |
$10K |
| D2140 |
|
157 |
77 |
$8K |
| D0350 |
|
524 |
472 |
$8K |
| D0603 |
|
404 |
399 |
$6K |
| D2954 |
|
51 |
37 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
38 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$2K |
| D4342 |
|
35 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |