| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,736 |
10,686 |
$599K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,313 |
4,641 |
$489K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,112 |
2,197 |
$364K |
| D1120 |
Prophylaxis - child |
9,217 |
9,189 |
$353K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72,917 |
15,192 |
$292K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,146 |
4,134 |
$261K |
| D4341 |
|
3,272 |
910 |
$228K |
| D1110 |
Prophylaxis - adult |
2,581 |
2,566 |
$218K |
| D2160 |
|
2,253 |
1,765 |
$179K |
| D2140 |
|
3,210 |
2,286 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
2,324 |
2,317 |
$109K |
| D9430 |
|
3,180 |
3,142 |
$101K |
| D0274 |
Bitewings - four radiographic images |
5,461 |
5,426 |
$98K |
| D2931 |
|
688 |
607 |
$86K |
| D0350 |
|
8,285 |
4,596 |
$78K |
| D1206 |
Topical application of fluoride varnish |
5,000 |
4,966 |
$77K |
| D0272 |
Bitewings - two radiographic images |
6,145 |
6,131 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,610 |
6,597 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,273 |
5,201 |
$62K |
| D4910 |
|
517 |
517 |
$40K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
82 |
64 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
556 |
344 |
$32K |
| D2791 |
|
18 |
17 |
$9K |
| D2330 |
|
46 |
29 |
$3K |
| D2161 |
|
20 |
15 |
$2K |
| D3221 |
|
25 |
25 |
$2K |
| D4342 |
|
37 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$902.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$280.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$0.00 |