| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,658 |
992 |
$192K |
| D1120 |
Prophylaxis - child |
6,544 |
5,605 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
4,321 |
3,655 |
$128K |
| D1206 |
Topical application of fluoride varnish |
6,747 |
5,711 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,501 |
3,801 |
$84K |
| D8670 |
Periodic orthodontic treatment visit |
937 |
679 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,607 |
282 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,370 |
2,021 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,147 |
514 |
$49K |
| D0330 |
Panoramic radiographic image |
1,264 |
1,026 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
697 |
594 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
291 |
62 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
491 |
256 |
$25K |
| D0272 |
Bitewings - two radiographic images |
932 |
768 |
$12K |
| D9222 |
|
173 |
112 |
$7K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
368 |
278 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
158 |
113 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
448 |
350 |
$4K |
| D7230 |
|
34 |
13 |
$3K |
| 70486 |
|
60 |
55 |
$3K |
| D2331 |
|
47 |
28 |
$1K |
| D0274 |
Bitewings - four radiographic images |
101 |
77 |
$1K |
| D1110 |
Prophylaxis - adult |
537 |
438 |
$931.70 |
| D0470 |
|
53 |
38 |
$797.39 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
40 |
$721.58 |
| D0350 |
|
68 |
51 |
$681.55 |
| D2330 |
|
29 |
17 |
$459.18 |
| D0340 |
|
35 |
24 |
$407.22 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
12 |
$336.00 |
| D9248 |
|
21 |
13 |
$68.00 |
| D0190 |
|
71 |
61 |
$0.00 |