| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,284 |
5,244 |
$292K |
| D1110 |
Prophylaxis - adult |
2,866 |
2,843 |
$237K |
| D1120 |
Prophylaxis - child |
5,519 |
5,463 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,414 |
3,390 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,573 |
7,284 |
$132K |
| D2140 |
|
2,100 |
956 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,336 |
2,329 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,031 |
7,972 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,457 |
853 |
$95K |
| D1351 |
Sealant - per tooth |
2,719 |
635 |
$73K |
| D0272 |
Bitewings - two radiographic images |
5,731 |
5,689 |
$66K |
| D9430 |
|
1,905 |
1,828 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
404 |
209 |
$45K |
| D0350 |
|
3,785 |
1,584 |
$38K |
| D4341 |
|
517 |
140 |
$36K |
| D4910 |
|
377 |
375 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,302 |
2,223 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
357 |
209 |
$20K |
| D1320 |
|
1,402 |
1,401 |
$19K |
| D0330 |
Panoramic radiographic image |
640 |
633 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
160 |
$14K |
| D2330 |
|
169 |
98 |
$13K |
| D9993 |
|
154 |
154 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
16 |
14 |
$7K |
| D1310 |
|
158 |
157 |
$7K |
| D2160 |
|
67 |
54 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
45 |
$4K |
| D2954 |
|
16 |
14 |
$2K |
| D0601 |
|
72 |
72 |
$1K |
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$1K |
| D0270 |
|
47 |
46 |
$235.00 |