| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,761 |
6,606 |
$190K |
| D1120 |
Prophylaxis - child |
6,875 |
6,721 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,512 |
2,118 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,852 |
7,683 |
$151K |
| D1351 |
Sealant - per tooth |
7,198 |
1,678 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,404 |
8,364 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,157 |
1,115 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,430 |
2,374 |
$88K |
| D1110 |
Prophylaxis - adult |
1,400 |
1,369 |
$80K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
178 |
134 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
8,993 |
8,650 |
$73K |
| D9430 |
|
2,587 |
2,464 |
$43K |
| D0274 |
Bitewings - four radiographic images |
3,803 |
3,724 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
392 |
392 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
1,534 |
1,502 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,102 |
598 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
176 |
109 |
$12K |
| D2332 |
|
187 |
95 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
108 |
108 |
$6K |
| D2954 |
|
103 |
77 |
$6K |
| D4341 |
|
168 |
57 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
96 |
$4K |
| D1999 |
|
138 |
135 |
$2K |
| D4910 |
|
17 |
17 |
$2K |