| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,221 |
1,207 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,111 |
664 |
$34K |
| D1120 |
Prophylaxis - child |
930 |
915 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
456 |
453 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,437 |
1,418 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
78 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
602 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
350 |
348 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
928 |
891 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
98 |
95 |
$2K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
64 |
54 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D1330 |
|
1,429 |
1,408 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
26 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,034 |
1,011 |
$805.55 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$787.60 |
| 99383 |
|
13 |
12 |
$708.84 |
| D0603 |
|
774 |
764 |
$415.00 |
| 99382 |
|
15 |
13 |
$393.80 |
| D1351 |
Sealant - per tooth |
187 |
64 |
$373.64 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$277.82 |
| D0272 |
Bitewings - two radiographic images |
134 |
131 |
$260.76 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
13 |
$160.72 |
| D0602 |
|
67 |
67 |
$130.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$123.05 |
| D1354 |
|
57 |
24 |
$86.10 |
| D9986 |
|
127 |
112 |
$0.00 |
| D0601 |
|
17 |
16 |
$0.00 |
| D1310 |
|
35 |
33 |
$0.00 |