| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,103 |
5,068 |
$281K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,375 |
1,909 |
$224K |
| D1120 |
Prophylaxis - child |
4,929 |
4,906 |
$188K |
| D1110 |
Prophylaxis - adult |
1,702 |
1,686 |
$142K |
| D1351 |
Sealant - per tooth |
4,971 |
1,755 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,150 |
2,134 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,249 |
5,231 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,192 |
2,169 |
$101K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
207 |
185 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,771 |
1,054 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,705 |
6,663 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,574 |
3,559 |
$75K |
| D0350 |
|
4,071 |
1,963 |
$39K |
| D4341 |
|
471 |
121 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
380 |
293 |
$30K |
| D2330 |
|
337 |
188 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
336 |
178 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
691 |
685 |
$8K |
| D2952 |
|
67 |
62 |
$7K |
| D0272 |
Bitewings - two radiographic images |
605 |
603 |
$7K |
| D2160 |
|
73 |
51 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
27 |
$4K |
| D1310 |
|
53 |
53 |
$2K |
| D9993 |
|
29 |
29 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$2K |
| D9430 |
|
26 |
26 |
$832.00 |
| D0242 |
|
62 |
32 |
$0.00 |