| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,485 |
9,444 |
$519K |
| D1120 |
Prophylaxis - child |
8,777 |
8,736 |
$335K |
| D2140 |
|
4,942 |
3,048 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,619 |
12,138 |
$265K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,137 |
1,409 |
$246K |
| D1351 |
Sealant - per tooth |
8,759 |
2,792 |
$235K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,275 |
2,384 |
$219K |
| D1110 |
Prophylaxis - adult |
2,259 |
2,243 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,953 |
2,936 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,168 |
1,692 |
$179K |
| D0274 |
Bitewings - four radiographic images |
8,447 |
8,412 |
$175K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
210 |
187 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,826 |
8,790 |
$93K |
| D0350 |
|
7,865 |
3,961 |
$75K |
| D9430 |
|
2,287 |
2,256 |
$72K |
| D9110 |
|
636 |
588 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,325 |
3,252 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,628 |
1,620 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
343 |
$16K |
| D2954 |
|
140 |
126 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
23 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
128 |
128 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
26 |
$2K |
| D1999 |
|
1,373 |
1,312 |
$90.00 |