| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9310 |
|
6,193 |
6,179 |
$275K |
| D1120 |
Prophylaxis - child |
6,570 |
6,565 |
$224K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,957 |
2,291 |
$219K |
| D1351 |
Sealant - per tooth |
4,690 |
1,626 |
$204K |
| D0330 |
Panoramic radiographic image |
5,213 |
5,212 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
6,258 |
6,255 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
12,589 |
12,567 |
$118K |
| D1206 |
Topical application of fluoride varnish |
4,202 |
4,199 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,554 |
1,015 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,491 |
4,488 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,098 |
1,471 |
$91K |
| D9243 |
|
772 |
739 |
$66K |
| D9239 |
|
729 |
719 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,860 |
7,846 |
$44K |
| D0160 |
|
1,855 |
1,855 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,552 |
3,547 |
$43K |
| D1110 |
Prophylaxis - adult |
983 |
980 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,139 |
2,138 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
251 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
154 |
153 |
$23K |
| D1354 |
|
256 |
146 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
25 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
292 |
$6K |
| D9110 |
|
288 |
288 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
28 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
13 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
13 |
$943.45 |
| D0140 |
Limited oral evaluation - problem focused |
69 |
69 |
$907.62 |
| 70310 |
|
29 |
29 |
$273.35 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$72.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$36.00 |