| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
810 |
740 |
$426K |
| D0140 |
Limited oral evaluation - problem focused |
12,508 |
11,828 |
$386K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,304 |
1,042 |
$325K |
| D0330 |
Panoramic radiographic image |
8,409 |
8,093 |
$256K |
| D0220 |
Intraoral - periapical first radiographic image |
12,510 |
11,865 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,745 |
5,585 |
$177K |
| D1206 |
Topical application of fluoride varnish |
3,654 |
3,526 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
2,619 |
2,523 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,651 |
7,838 |
$127K |
| D5120 |
|
193 |
171 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,114 |
386 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,276 |
4,115 |
$93K |
| D5899 |
|
4,069 |
2,617 |
$86K |
| D1120 |
Prophylaxis - child |
1,839 |
1,795 |
$81K |
| D1110 |
Prophylaxis - adult |
2,184 |
2,146 |
$68K |
| D0160 |
|
1,916 |
1,794 |
$62K |
| D1351 |
Sealant - per tooth |
2,767 |
431 |
$58K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
899 |
460 |
$49K |
| D5214 |
|
93 |
84 |
$47K |
| D9310 |
|
659 |
648 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,124 |
$36K |
| D7310 |
|
445 |
152 |
$33K |
| D5130 |
|
51 |
50 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
598 |
323 |
$30K |
| D9222 |
|
475 |
453 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,011 |
977 |
$17K |
| D7250 |
|
232 |
47 |
$12K |
| D7311 |
|
204 |
82 |
$9K |
| D5140 |
|
13 |
12 |
$8K |
| D0270 |
|
791 |
757 |
$8K |
| D7220 |
|
51 |
30 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
40 |
23 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
23 |
12 |
$7K |
| D2950 |
|
52 |
24 |
$6K |
| D5213 |
|
12 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
76 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
162 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
29 |
$870.00 |
| D1353 |
|
48 |
12 |
$754.40 |
| D0170 |
|
31 |
30 |
$503.36 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$280.00 |
| D0190 |
|
13 |
13 |
$170.88 |
| D0603 |
|
270 |
243 |
$167.00 |
| D9995 |
|
13 |
13 |
$100.00 |
| D0602 |
|
56 |
47 |
$41.00 |
| D0601 |
|
29 |
29 |
$29.00 |
| D1999 |
|
2,562 |
2,234 |
$0.00 |