| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,966 |
12,898 |
$294K |
| D2140 |
|
5,600 |
2,268 |
$214K |
| D8670 |
Periodic orthodontic treatment visit |
3,769 |
3,678 |
$214K |
| D1110 |
Prophylaxis - adult |
6,543 |
6,516 |
$183K |
| D1120 |
Prophylaxis - child |
5,652 |
5,639 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,359 |
7,334 |
$107K |
| D0272 |
Bitewings - two radiographic images |
11,219 |
11,146 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,976 |
1,050 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,487 |
851 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,401 |
1,397 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,110 |
2,101 |
$47K |
| D4355 |
|
756 |
746 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
10,474 |
10,249 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
634 |
411 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
777 |
472 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
486 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,383 |
8,666 |
$33K |
| D4341 |
|
758 |
271 |
$29K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,330 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
915 |
891 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,721 |
1,707 |
$25K |
| D2752 |
|
44 |
40 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
202 |
112 |
$11K |
| D2954 |
|
53 |
49 |
$5K |
| D2332 |
|
101 |
54 |
$5K |
| D9110 |
|
226 |
222 |
$3K |
| D2160 |
|
43 |
28 |
$2K |
| D1351 |
Sealant - per tooth |
97 |
13 |
$2K |
| D2335 |
|
13 |
12 |
$931.00 |
| D8660 |
|
17 |
17 |
$745.00 |
| D2330 |
|
17 |
12 |
$631.75 |
| D0350 |
|
94 |
16 |
$28.00 |