| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
65,314 |
56,742 |
$3.66M |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17,957 |
16,776 |
$1.84M |
| D1120 |
Prophylaxis - child |
22,943 |
22,679 |
$824K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,699 |
7,590 |
$568K |
| D1351 |
Sealant - per tooth |
12,336 |
5,835 |
$543K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,917 |
2,737 |
$477K |
| D0330 |
Panoramic radiographic image |
11,978 |
11,744 |
$359K |
| D1354 |
|
16,837 |
7,576 |
$353K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,966 |
4,185 |
$308K |
| D1206 |
Topical application of fluoride varnish |
11,821 |
11,778 |
$294K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,342 |
4,246 |
$248K |
| D0272 |
Bitewings - two radiographic images |
18,602 |
18,524 |
$229K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,375 |
1,637 |
$228K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,924 |
6,326 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,009 |
13,984 |
$172K |
| D1110 |
Prophylaxis - adult |
4,410 |
4,397 |
$168K |
| D0274 |
Bitewings - four radiographic images |
6,786 |
6,472 |
$133K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,661 |
1,652 |
$124K |
| D7240 |
Removal of impacted tooth - completely bony |
343 |
196 |
$116K |
| D9222 |
|
2,029 |
1,968 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
11,923 |
11,780 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,625 |
7,239 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
4,409 |
4,239 |
$69K |
| D8670 |
Periodic orthodontic treatment visit |
279 |
275 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
3,922 |
3,890 |
$64K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
133 |
126 |
$45K |
| D9310 |
|
1,248 |
1,248 |
$41K |
| D3320 |
|
148 |
142 |
$39K |
| D0240 |
|
2,419 |
2,380 |
$30K |
| D0367 |
|
97 |
97 |
$27K |
| D7230 |
|
103 |
81 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
539 |
519 |
$16K |
| D6010 |
|
19 |
17 |
$14K |
| D3310 |
|
64 |
51 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
206 |
187 |
$12K |
| D9610 |
|
866 |
844 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
141 |
108 |
$10K |
| D8660 |
|
401 |
372 |
$10K |
| D0340 |
|
196 |
193 |
$9K |
| D2331 |
|
134 |
112 |
$7K |
| D0470 |
|
189 |
189 |
$6K |
| D2330 |
|
113 |
90 |
$5K |
| D0270 |
|
447 |
444 |
$4K |
| D0350 |
|
219 |
219 |
$2K |
| D9920 |
|
253 |
251 |
$2K |
| D2335 |
|
15 |
12 |
$2K |
| D4341 |
|
36 |
24 |
$2K |
| D9110 |
|
72 |
71 |
$2K |
| D9630 |
|
604 |
588 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,230 |
2,191 |
$960.71 |
| D2332 |
|
12 |
12 |
$846.59 |
| D1330 |
|
11,880 |
11,865 |
$572.04 |
| D1999 |
|
462 |
462 |
$0.00 |
| D0180 |
|
13 |
13 |
$0.00 |
| D9215 |
|
2,798 |
2,776 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
1,697 |
1,625 |
$0.00 |
| D9248 |
|
68 |
67 |
$0.00 |
| D6999 |
|
25 |
25 |
$0.00 |
| D5899 |
|
46 |
40 |
$0.00 |