| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,602 |
13,538 |
$775K |
| D1120 |
Prophylaxis - child |
14,907 |
14,830 |
$569K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87,942 |
17,191 |
$384K |
| D1351 |
Sealant - per tooth |
8,826 |
1,944 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,261 |
17,174 |
$226K |
| D0274 |
Bitewings - four radiographic images |
8,650 |
8,594 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,568 |
1,355 |
$169K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,554 |
1,321 |
$167K |
| D1110 |
Prophylaxis - adult |
1,872 |
1,860 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,390 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,620 |
1,348 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
7,889 |
7,773 |
$92K |
| D9430 |
|
2,727 |
2,565 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,413 |
900 |
$80K |
| D1310 |
|
1,592 |
1,586 |
$73K |
| D0350 |
|
5,470 |
3,283 |
$61K |
| D2140 |
|
857 |
427 |
$45K |
| D9993 |
|
553 |
552 |
$35K |
| D4910 |
|
377 |
374 |
$29K |
| D8670 |
Periodic orthodontic treatment visit |
90 |
90 |
$26K |
| D2330 |
|
357 |
188 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
452 |
448 |
$24K |
| D0603 |
|
687 |
685 |
$10K |
| D0601 |
|
540 |
539 |
$8K |
| D4341 |
|
85 |
24 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
152 |
$5K |
| D2160 |
|
57 |
47 |
$4K |
| D0270 |
|
856 |
846 |
$4K |
| D0272 |
Bitewings - two radiographic images |
226 |
223 |
$2K |
| D9110 |
|
27 |
27 |
$2K |
| D0602 |
|
96 |
96 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D1320 |
|
24 |
23 |
$275.00 |