| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,784 |
7,732 |
$425K |
| D1120 |
Prophylaxis - child |
7,104 |
7,029 |
$266K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,371 |
11,204 |
$227K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
457 |
351 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,961 |
2,902 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,747 |
1,366 |
$180K |
| D1110 |
Prophylaxis - adult |
1,969 |
1,958 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,629 |
1,184 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,384 |
9,301 |
$112K |
| D0272 |
Bitewings - two radiographic images |
9,526 |
9,443 |
$111K |
| D1351 |
Sealant - per tooth |
3,592 |
844 |
$91K |
| D4341 |
|
1,320 |
363 |
$90K |
| D9430 |
|
2,298 |
2,179 |
$72K |
| D4910 |
|
903 |
893 |
$68K |
| D0350 |
|
4,954 |
2,018 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
693 |
291 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
445 |
265 |
$24K |
| D1310 |
|
462 |
462 |
$21K |
| D9993 |
|
364 |
364 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,684 |
1,658 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
399 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
75 |
$8K |
| D2954 |
|
58 |
55 |
$6K |
| D2160 |
|
43 |
26 |
$3K |
| D0601 |
|
210 |
210 |
$3K |
| D4342 |
|
51 |
15 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$810.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$345.60 |