| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,319 |
3,307 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,703 |
2,691 |
$179K |
| D1120 |
Prophylaxis - child |
3,720 |
3,708 |
$177K |
| D1110 |
Prophylaxis - adult |
1,938 |
1,930 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,572 |
1,395 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
2,051 |
2,041 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,923 |
4,667 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,587 |
967 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,188 |
5,173 |
$71K |
| D1351 |
Sealant - per tooth |
1,823 |
514 |
$67K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
129 |
113 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,640 |
2,629 |
$57K |
| D4910 |
|
621 |
616 |
$48K |
| D4341 |
|
603 |
222 |
$42K |
| D0350 |
|
3,404 |
1,492 |
$37K |
| D9430 |
|
790 |
755 |
$25K |
| D1310 |
|
493 |
488 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
135 |
$15K |
| D1206 |
Topical application of fluoride varnish |
430 |
425 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,023 |
996 |
$12K |
| D0272 |
Bitewings - two radiographic images |
771 |
770 |
$9K |
| D9993 |
|
94 |
94 |
$4K |
| D0603 |
|
209 |
205 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
12 |
$2K |
| D2331 |
|
17 |
12 |
$1K |