| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,501 |
13,358 |
$299K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,474 |
2,367 |
$277K |
| D1206 |
Topical application of fluoride varnish |
15,013 |
14,724 |
$211K |
| D1120 |
Prophylaxis - child |
8,568 |
8,455 |
$189K |
| D1351 |
Sealant - per tooth |
7,829 |
2,419 |
$160K |
| D1110 |
Prophylaxis - adult |
3,982 |
3,922 |
$139K |
| D0330 |
Panoramic radiographic image |
4,955 |
4,772 |
$136K |
| D2140 |
|
3,280 |
1,490 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,454 |
3,256 |
$94K |
| D0274 |
Bitewings - four radiographic images |
6,891 |
6,691 |
$75K |
| D7240 |
Removal of impacted tooth - completely bony |
351 |
99 |
$68K |
| D0272 |
Bitewings - two radiographic images |
5,615 |
5,546 |
$56K |
| D2160 |
|
810 |
538 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,261 |
592 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
659 |
268 |
$43K |
| D1999 |
|
2,876 |
2,597 |
$39K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,431 |
1,393 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
633 |
245 |
$36K |
| D4341 |
|
1,498 |
674 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,180 |
3,951 |
$27K |
| D4910 |
|
459 |
451 |
$20K |
| D2331 |
|
331 |
155 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
820 |
790 |
$15K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
40 |
38 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,720 |
1,323 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
37 |
$4K |
| D2332 |
|
45 |
27 |
$3K |
| D0240 |
|
15 |
14 |
$124.74 |