| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,907 |
2,820 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
5,425 |
5,054 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,618 |
670 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,533 |
1,394 |
$93K |
| D9243 |
|
2,420 |
606 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,080 |
249 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,180 |
2,105 |
$65K |
| D9239 |
|
824 |
787 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
794 |
275 |
$58K |
| D7240 |
Removal of impacted tooth - completely bony |
256 |
105 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
623 |
333 |
$43K |
| D1110 |
Prophylaxis - adult |
1,052 |
1,012 |
$39K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
483 |
112 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,212 |
1,173 |
$24K |
| D9612 |
|
413 |
402 |
$20K |
| D9222 |
|
119 |
112 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,882 |
786 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
130 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
622 |
596 |
$11K |
| D2394 |
|
124 |
58 |
$9K |
| D2331 |
|
89 |
41 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,588 |
1,437 |
$9K |
| D2335 |
|
89 |
32 |
$8K |
| D7230 |
|
39 |
24 |
$6K |
| D2332 |
|
69 |
43 |
$5K |
| D0250 |
|
406 |
398 |
$5K |
| D1206 |
Topical application of fluoride varnish |
288 |
269 |
$4K |
| D1120 |
Prophylaxis - child |
108 |
96 |
$2K |
| D1351 |
Sealant - per tooth |
64 |
14 |
$1K |
| D9610 |
|
15 |
14 |
$352.52 |