| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,367 |
9,312 |
$500K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,023 |
629 |
$474K |
| D1120 |
Prophylaxis - child |
7,500 |
7,465 |
$279K |
| D4341 |
|
3,963 |
1,131 |
$270K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,584 |
13,259 |
$209K |
| D0274 |
Bitewings - four radiographic images |
8,511 |
8,458 |
$178K |
| D4910 |
|
2,328 |
2,315 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,792 |
2,779 |
$166K |
| D1110 |
Prophylaxis - adult |
1,834 |
1,823 |
$152K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,135 |
976 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,704 |
9,658 |
$118K |
| D2160 |
|
642 |
497 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
673 |
354 |
$44K |
| D1351 |
Sealant - per tooth |
1,518 |
348 |
$38K |
| D2954 |
|
352 |
280 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
265 |
172 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,605 |
2,594 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,520 |
2,491 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
569 |
309 |
$29K |
| D9430 |
|
873 |
857 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
186 |
$21K |
| D0350 |
|
2,437 |
1,222 |
$20K |
| D4342 |
|
451 |
150 |
$18K |
| D0330 |
Panoramic radiographic image |
628 |
622 |
$18K |
| D2140 |
|
310 |
169 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
25 |
$12K |
| D3320 |
|
16 |
14 |
$6K |
| D2330 |
|
88 |
49 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
21 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
28 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D0270 |
|
12 |
12 |
$55.00 |
| D1999 |
|
60 |
60 |
$0.00 |