| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,801 |
3,777 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,321 |
3,303 |
$208K |
| D1120 |
Prophylaxis - child |
3,669 |
3,637 |
$139K |
| D1110 |
Prophylaxis - adult |
1,540 |
1,531 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,377 |
5,112 |
$122K |
| D1351 |
Sealant - per tooth |
4,255 |
1,093 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
2,119 |
2,109 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,383 |
3,357 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,989 |
4,950 |
$60K |
| D0350 |
|
5,550 |
1,695 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
781 |
490 |
$52K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
49 |
40 |
$23K |
| D2140 |
|
260 |
137 |
$14K |
| D9430 |
|
244 |
241 |
$8K |
| D0272 |
Bitewings - two radiographic images |
475 |
474 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
473 |
469 |
$5K |
| D0330 |
Panoramic radiographic image |
167 |
167 |
$5K |
| D1206 |
Topical application of fluoride varnish |
178 |
178 |
$3K |
| D4910 |
|
27 |
27 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$2K |