| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
25,635 |
24,085 |
$310K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,182 |
6,536 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
23,060 |
22,018 |
$152K |
| D0220 |
Intraoral - periapical first radiographic image |
35,564 |
34,635 |
$114K |
| D1120 |
Prophylaxis - child |
13,644 |
13,493 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
9,712 |
8,907 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,975 |
6,416 |
$67K |
| D0274 |
Bitewings - four radiographic images |
11,925 |
11,851 |
$44K |
| D0330 |
Panoramic radiographic image |
2,603 |
2,547 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
3,607 |
3,581 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,065 |
759 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,905 |
16,832 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,132 |
22,946 |
$34K |
| D9110 |
|
2,278 |
2,111 |
$24K |
| D0272 |
Bitewings - two radiographic images |
6,881 |
6,848 |
$20K |
| D9310 |
|
1,406 |
1,323 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
425 |
225 |
$19K |
| D0270 |
|
5,097 |
5,015 |
$19K |
| D0999 |
Unspecified diagnostic procedure, by report |
454 |
412 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,176 |
1,072 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
376 |
$5K |
| D1354 |
|
717 |
190 |
$5K |
| D1206 |
Topical application of fluoride varnish |
895 |
895 |
$4K |
| D9990 |
|
618 |
603 |
$3K |
| D9920 |
|
1,768 |
1,680 |
$3K |
| D9243 |
|
104 |
101 |
$2K |
| D1310 |
|
2,368 |
2,223 |
$2K |
| D1351 |
Sealant - per tooth |
120 |
64 |
$2K |
| D9239 |
|
104 |
104 |
$1K |
| D7240 |
Removal of impacted tooth - completely bony |
25 |
12 |
$1K |
| D1330 |
|
2,634 |
2,502 |
$938.64 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
113 |
$750.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
45 |
$459.70 |
| D7999 |
|
46 |
46 |
$447.42 |
| D9430 |
|
17 |
15 |
$178.18 |
| D0240 |
|
41 |
38 |
$162.88 |
| D0350 |
|
12 |
12 |
$78.88 |
| D2140 |
|
15 |
13 |
$52.24 |
| D0190 |
|
13 |
13 |
$0.00 |
| D0171 |
|
29 |
27 |
$0.00 |