| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,427 |
5,392 |
$295K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,770 |
1,792 |
$250K |
| D1120 |
Prophylaxis - child |
5,544 |
5,512 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,193 |
2,185 |
$136K |
| D2140 |
|
2,476 |
1,133 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,723 |
6,102 |
$127K |
| D1110 |
Prophylaxis - adult |
1,242 |
1,238 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,908 |
6,870 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,605 |
1,600 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,735 |
2,719 |
$58K |
| D0350 |
|
4,230 |
1,968 |
$55K |
| D1351 |
Sealant - per tooth |
1,328 |
386 |
$46K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
62 |
39 |
$30K |
| D1310 |
|
586 |
586 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,182 |
2,162 |
$26K |
| D2160 |
|
316 |
202 |
$25K |
| D9430 |
|
793 |
778 |
$24K |
| D9993 |
|
324 |
324 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,605 |
1,598 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
264 |
154 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
27 |
$5K |
| D2954 |
|
44 |
27 |
$5K |
| D0601 |
|
162 |
162 |
$2K |
| D0603 |
|
82 |
82 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$450.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$336.00 |
| D1330 |
|
24 |
24 |
$0.00 |