| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,805 |
4,785 |
$268K |
| D1120 |
Prophylaxis - child |
4,400 |
4,374 |
$164K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,179 |
1,252 |
$146K |
| D1110 |
Prophylaxis - adult |
1,364 |
1,362 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,598 |
5,323 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,633 |
1,631 |
$103K |
| D4910 |
|
1,113 |
1,112 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,744 |
5,715 |
$65K |
| D0272 |
Bitewings - two radiographic images |
4,949 |
4,921 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,183 |
1,172 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
724 |
472 |
$48K |
| D9430 |
|
1,382 |
1,287 |
$44K |
| D1351 |
Sealant - per tooth |
1,841 |
571 |
$43K |
| D4341 |
|
628 |
173 |
$43K |
| D2140 |
|
697 |
420 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
71 |
56 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
577 |
367 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
116 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,010 |
986 |
$12K |
| D2160 |
|
146 |
96 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
37 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
15 |
$3K |
| D2954 |
|
15 |
12 |
$2K |