| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,949 |
5,910 |
$349K |
| D1120 |
Prophylaxis - child |
5,878 |
5,837 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,757 |
2,749 |
$172K |
| D1110 |
Prophylaxis - adult |
1,992 |
1,986 |
$171K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,268 |
7,550 |
$130K |
| D4341 |
|
1,647 |
450 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,191 |
6,145 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,605 |
1,601 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,249 |
3,219 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
917 |
548 |
$61K |
| D9430 |
|
1,313 |
1,172 |
$42K |
| D4910 |
|
488 |
476 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,736 |
1,733 |
$31K |
| D0350 |
|
2,313 |
918 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
189 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
309 |
182 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
155 |
81 |
$18K |
| D1310 |
|
381 |
380 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,299 |
1,251 |
$15K |
| D1351 |
Sealant - per tooth |
500 |
132 |
$14K |
| D0330 |
Panoramic radiographic image |
390 |
390 |
$11K |
| D0272 |
Bitewings - two radiographic images |
955 |
951 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
106 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
13 |
$6K |
| D2140 |
|
103 |
68 |
$5K |
| D0601 |
|
159 |
159 |
$2K |