| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
156,845 |
156,814 |
$896K |
| D0120 |
Periodic oral evaluation - established patient |
4,842 |
4,733 |
$134K |
| D1110 |
Prophylaxis - adult |
2,910 |
2,829 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
900 |
677 |
$100K |
| D1120 |
Prophylaxis - child |
2,335 |
2,283 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,882 |
3,755 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
3,245 |
3,116 |
$54K |
| D0330 |
Panoramic radiographic image |
832 |
797 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,205 |
1,169 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
412 |
$45K |
| D1351 |
Sealant - per tooth |
1,564 |
437 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,157 |
1,114 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,548 |
1,861 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
627 |
601 |
$28K |
| D0272 |
Bitewings - two radiographic images |
816 |
797 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
118 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
105 |
$5K |
| D4341 |
|
26 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$947.64 |