| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,838 |
7,767 |
$470K |
| D1120 |
Prophylaxis - child |
7,492 |
7,423 |
$294K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59,930 |
11,212 |
$256K |
| D1110 |
Prophylaxis - adult |
2,556 |
2,529 |
$224K |
| D1351 |
Sealant - per tooth |
7,142 |
1,356 |
$213K |
| D0274 |
Bitewings - four radiographic images |
8,198 |
8,128 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,502 |
2,472 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,174 |
10,076 |
$121K |
| D9430 |
|
1,716 |
1,685 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
642 |
356 |
$43K |
| D9110 |
|
498 |
498 |
$31K |
| D2160 |
|
244 |
157 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,565 |
1,544 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
108 |
$5K |
| D1320 |
|
179 |
178 |
$3K |
| D1310 |
|
68 |
68 |
$2K |
| D0602 |
|
53 |
53 |
$390.00 |
| D1999 |
|
1,455 |
1,390 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
1,298 |
1,241 |
$0.00 |