| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,164 |
6,152 |
$394K |
| D1110 |
Prophylaxis - adult |
4,235 |
4,232 |
$367K |
| D1351 |
Sealant - per tooth |
11,427 |
1,902 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
4,054 |
4,047 |
$258K |
| D1120 |
Prophylaxis - child |
4,347 |
4,342 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,973 |
1,420 |
$169K |
| D0274 |
Bitewings - four radiographic images |
6,962 |
6,951 |
$148K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,061 |
1,590 |
$138K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
692 |
602 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,136 |
6,105 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,757 |
8,037 |
$71K |
| D2140 |
|
1,272 |
936 |
$69K |
| D9430 |
|
2,023 |
1,983 |
$64K |
| D2160 |
|
653 |
558 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
925 |
922 |
$44K |
| D0330 |
Panoramic radiographic image |
1,135 |
1,130 |
$34K |
| D2330 |
|
366 |
244 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,979 |
1,959 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
23 |
18 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
14 |
$10K |
| D2954 |
|
85 |
61 |
$9K |
| D1206 |
Topical application of fluoride varnish |
415 |
415 |
$7K |
| D2331 |
|
42 |
28 |
$3K |
| D3221 |
|
23 |
15 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$1K |