| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,734 |
13,717 |
$803K |
| D2740 |
Crown - porcelain/ceramic |
1,215 |
790 |
$574K |
| D1120 |
Prophylaxis - child |
13,009 |
12,978 |
$512K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,411 |
1,405 |
$404K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,014 |
3,522 |
$398K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,401 |
5,385 |
$343K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,446 |
13,154 |
$334K |
| D0210 |
Intraoral - complete series of radiographic images |
6,398 |
6,377 |
$297K |
| D1110 |
Prophylaxis - adult |
3,313 |
3,305 |
$284K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,493 |
16,452 |
$210K |
| D1351 |
Sealant - per tooth |
6,305 |
1,564 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,020 |
1,447 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,761 |
1,807 |
$147K |
| D0274 |
Bitewings - four radiographic images |
6,865 |
6,852 |
$144K |
| D0350 |
|
9,135 |
5,816 |
$139K |
| D1320 |
|
8,417 |
8,389 |
$88K |
| D1310 |
|
1,988 |
1,982 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,383 |
717 |
$79K |
| D2954 |
|
674 |
521 |
$70K |
| D9430 |
|
2,224 |
2,190 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,589 |
5,545 |
$66K |
| D9993 |
|
862 |
862 |
$46K |
| D2330 |
|
350 |
224 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,054 |
2,052 |
$24K |
| D0601 |
|
604 |
604 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
132 |
$8K |
| D4341 |
|
89 |
24 |
$5K |
| D0603 |
|
260 |
260 |
$4K |
| D2931 |
|
29 |
26 |
$4K |
| D0602 |
|
78 |
78 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |
| D3120 |
|
106 |
77 |
$0.00 |