| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,658 |
3,615 |
$275K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
408 |
307 |
$194K |
| D1120 |
Prophylaxis - child |
3,139 |
3,100 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,186 |
2,168 |
$145K |
| D1351 |
Sealant - per tooth |
3,863 |
1,066 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,487 |
2,467 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,766 |
1,104 |
$118K |
| D4341 |
|
1,658 |
447 |
$116K |
| D1110 |
Prophylaxis - adult |
1,017 |
1,006 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,462 |
634 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
606 |
436 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,094 |
4,220 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,297 |
2,269 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,126 |
3,087 |
$49K |
| D2140 |
|
837 |
514 |
$45K |
| D2954 |
|
378 |
293 |
$40K |
| D0350 |
|
3,448 |
1,605 |
$34K |
| D2160 |
|
372 |
261 |
$30K |
| D9430 |
|
824 |
792 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,019 |
1,008 |
$18K |
| D1310 |
|
121 |
121 |
$5K |
| D3310 |
|
15 |
12 |
$5K |
| D4910 |
|
54 |
54 |
$4K |
| D0270 |
|
439 |
429 |
$2K |
| D0272 |
Bitewings - two radiographic images |
121 |
121 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$928.20 |