| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,924 |
11,878 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
6,570 |
6,539 |
$359K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,246 |
5,230 |
$301K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,811 |
10,921 |
$202K |
| D1351 |
Sealant - per tooth |
4,416 |
919 |
$167K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
320 |
271 |
$152K |
| D0272 |
Bitewings - two radiographic images |
8,622 |
8,580 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,090 |
523 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
998 |
556 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,493 |
1,492 |
$66K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
122 |
117 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
624 |
397 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,120 |
2,117 |
$25K |
| D2954 |
|
214 |
176 |
$22K |
| D2160 |
|
260 |
169 |
$21K |
| D1110 |
Prophylaxis - adult |
182 |
182 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
153 |
153 |
$7K |
| D2332 |
|
85 |
41 |
$7K |
| D4341 |
|
55 |
14 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
14 |
$3K |
| D2330 |
|
23 |
16 |
$2K |
| D9430 |
|
38 |
38 |
$1K |