| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,003 |
2,983 |
$174K |
| D1110 |
Prophylaxis - adult |
1,847 |
1,829 |
$156K |
| D1120 |
Prophylaxis - child |
2,122 |
2,109 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,005 |
1,000 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,792 |
3,766 |
$47K |
| D0272 |
Bitewings - two radiographic images |
3,384 |
3,362 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,618 |
3,512 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
271 |
150 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
284 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
14 |
$11K |
| D9430 |
|
301 |
293 |
$9K |
| D1351 |
Sealant - per tooth |
299 |
79 |
$9K |
| D4341 |
|
46 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
158 |
$2K |
| D2140 |
|
39 |
25 |
$2K |
| D9993 |
|
14 |
14 |
$700.00 |
| D1310 |
|
14 |
14 |
$560.00 |