| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,993 |
18,985 |
$1.07M |
| D1120 |
Prophylaxis - child |
18,320 |
18,306 |
$707K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114,500 |
20,734 |
$469K |
| D1351 |
Sealant - per tooth |
13,947 |
4,965 |
$383K |
| D0274 |
Bitewings - four radiographic images |
14,850 |
14,848 |
$316K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,053 |
2,623 |
$268K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,053 |
2,340 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,303 |
18,296 |
$198K |
| D1110 |
Prophylaxis - adult |
1,844 |
1,843 |
$157K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,949 |
1,154 |
$129K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
238 |
186 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,071 |
1,564 |
$109K |
| D7240 |
Removal of impacted tooth - completely bony |
428 |
213 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,119 |
1,118 |
$71K |
| D0350 |
|
5,678 |
3,297 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,822 |
3,820 |
$45K |
| D1310 |
|
969 |
969 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,818 |
1,811 |
$39K |
| D2330 |
|
485 |
319 |
$36K |
| D4341 |
|
520 |
186 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
415 |
367 |
$33K |
| D2140 |
|
587 |
463 |
$32K |
| D9993 |
|
424 |
424 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,225 |
2,204 |
$26K |
| D2954 |
|
247 |
196 |
$26K |
| D2160 |
|
182 |
156 |
$15K |
| D9430 |
|
423 |
407 |
$13K |
| D4910 |
|
101 |
101 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$6K |
| D0603 |
|
94 |
94 |
$1K |
| D0602 |
|
38 |
38 |
$570.00 |
| D0601 |
|
12 |
12 |
$180.00 |