| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,268 |
9,190 |
$495K |
| D1120 |
Prophylaxis - child |
8,704 |
8,641 |
$332K |
| D1110 |
Prophylaxis - adult |
3,538 |
3,504 |
$299K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,548 |
3,234 |
$298K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,985 |
2,157 |
$225K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,460 |
3,448 |
$213K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
431 |
338 |
$204K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,136 |
9,686 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
2,785 |
2,772 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
10,132 |
10,029 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,108 |
10,031 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,759 |
1,253 |
$94K |
| D2160 |
|
1,073 |
915 |
$84K |
| D1351 |
Sealant - per tooth |
3,185 |
742 |
$73K |
| D9430 |
|
2,194 |
2,150 |
$69K |
| D2330 |
|
648 |
451 |
$48K |
| D2140 |
|
486 |
390 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
156 |
$13K |
| D2331 |
|
120 |
88 |
$9K |
| D5211 |
|
12 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
138 |
137 |
$2K |
| D9920 |
|
27 |
26 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| D2954 |
|
14 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
84 |
84 |
$1K |
| D0330 |
Panoramic radiographic image |
72 |
70 |
$1K |
| D0272 |
Bitewings - two radiographic images |
59 |
59 |
$590.00 |
| D9993 |
|
99 |
99 |
$585.00 |
| D0601 |
|
29 |
29 |
$15.00 |
| D1330 |
|
1,277 |
1,267 |
$0.00 |
| D1310 |
|
85 |
85 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |