| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,868 |
4,841 |
$277K |
| D1120 |
Prophylaxis - child |
4,372 |
4,349 |
$170K |
| D1110 |
Prophylaxis - adult |
1,627 |
1,620 |
$144K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,082 |
1,054 |
$139K |
| D1351 |
Sealant - per tooth |
4,390 |
1,044 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,806 |
1,801 |
$116K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
239 |
172 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,261 |
7,017 |
$95K |
| D4341 |
|
1,251 |
325 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,060 |
6,027 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,573 |
4,550 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,703 |
1,695 |
$36K |
| D9430 |
|
550 |
544 |
$18K |
| D2140 |
|
245 |
154 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
105 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
923 |
$11K |
| D1310 |
|
247 |
247 |
$11K |
| D9993 |
|
159 |
158 |
$10K |
| D2160 |
|
81 |
53 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
71 |
$6K |
| D2332 |
|
64 |
38 |
$5K |
| D2954 |
|
38 |
30 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
24 |
$4K |
| D2330 |
|
15 |
12 |
$1K |
| D1999 |
|
172 |
152 |
$20.00 |