| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,721 |
7,686 |
$431K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,311 |
1,958 |
$346K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
690 |
407 |
$319K |
| D1110 |
Prophylaxis - adult |
3,081 |
3,066 |
$262K |
| D1120 |
Prophylaxis - child |
6,771 |
6,749 |
$256K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,282 |
3,250 |
$203K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,482 |
720 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,221 |
8,469 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
3,595 |
3,575 |
$165K |
| D2160 |
|
1,662 |
895 |
$129K |
| D2140 |
|
2,413 |
1,095 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,524 |
9,490 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,904 |
847 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,673 |
4,658 |
$98K |
| D9430 |
|
2,360 |
2,167 |
$74K |
| D1351 |
Sealant - per tooth |
2,779 |
661 |
$69K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
150 |
125 |
$68K |
| D2954 |
|
658 |
406 |
$68K |
| D0350 |
|
4,069 |
1,635 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,963 |
1,913 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,850 |
1,850 |
$21K |
| D1206 |
Topical application of fluoride varnish |
645 |
641 |
$9K |
| D2330 |
|
91 |
38 |
$7K |
| D4341 |
|
43 |
12 |
$3K |
| D0270 |
|
589 |
569 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
13 |
$2K |
| D1999 |
|
1,280 |
1,276 |
$954.50 |
| D1330 |
|
1,969 |
1,965 |
$0.00 |