| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,039 |
10,991 |
$615K |
| D1120 |
Prophylaxis - child |
11,165 |
11,119 |
$426K |
| D1351 |
Sealant - per tooth |
13,831 |
3,148 |
$387K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,657 |
4,644 |
$288K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,916 |
3,220 |
$281K |
| D1110 |
Prophylaxis - adult |
3,201 |
3,192 |
$274K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,046 |
2,091 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,364 |
14,309 |
$177K |
| D0272 |
Bitewings - two radiographic images |
11,887 |
11,837 |
$140K |
| D2140 |
|
2,415 |
1,518 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,794 |
14,909 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
7,573 |
7,243 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
650 |
526 |
$77K |
| D9430 |
|
1,801 |
1,784 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$8K |
| D0274 |
Bitewings - four radiographic images |
325 |
325 |
$7K |
| D2160 |
|
76 |
71 |
$6K |
| D4341 |
|
38 |
12 |
$3K |
| D9110 |
|
42 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
15 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |