| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,240 |
3,190 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,124 |
2,104 |
$113K |
| D1120 |
Prophylaxis - child |
2,195 |
2,178 |
$66K |
| D1110 |
Prophylaxis - adult |
631 |
621 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,590 |
4,315 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
262 |
116 |
$31K |
| D4341 |
|
423 |
161 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
725 |
716 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,898 |
1,865 |
$23K |
| D1206 |
Topical application of fluoride varnish |
2,097 |
2,063 |
$22K |
| D9430 |
|
935 |
894 |
$18K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
123 |
100 |
$17K |
| D9222 |
|
113 |
113 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
3,183 |
2,889 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
26 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
130 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
443 |
443 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
55 |
53 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
33 |
13 |
$6K |
| D1351 |
Sealant - per tooth |
251 |
57 |
$6K |
| D0272 |
Bitewings - two radiographic images |
743 |
734 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
89 |
$4K |
| D7230 |
|
22 |
12 |
$4K |
| D4910 |
|
53 |
53 |
$3K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$3K |
| D9248 |
|
56 |
54 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$832.10 |
| D1330 |
|
555 |
535 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
63 |
57 |
$0.00 |