| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,032 |
7,998 |
$411K |
| D1120 |
Prophylaxis - child |
6,647 |
6,615 |
$235K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,913 |
8,202 |
$186K |
| D1110 |
Prophylaxis - adult |
1,971 |
1,956 |
$170K |
| D0274 |
Bitewings - four radiographic images |
6,938 |
6,907 |
$146K |
| D1351 |
Sealant - per tooth |
4,633 |
1,527 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,856 |
8,814 |
$97K |
| D2140 |
|
1,245 |
658 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
909 |
906 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
863 |
359 |
$47K |
| D0350 |
|
4,753 |
2,123 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
505 |
329 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
608 |
608 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
131 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
249 |
167 |
$14K |
| D7230 |
|
41 |
16 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
32 |
15 |
$7K |
| D9430 |
|
229 |
227 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
510 |
$6K |
| D0272 |
Bitewings - two radiographic images |
370 |
370 |
$4K |
| D0330 |
Panoramic radiographic image |
114 |
114 |
$3K |
| D4910 |
|
26 |
26 |
$2K |