| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,298 |
6,699 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
8,267 |
7,628 |
$172K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
606 |
545 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
5,447 |
4,831 |
$138K |
| D0274 |
Bitewings - four radiographic images |
4,771 |
4,394 |
$129K |
| D1206 |
Topical application of fluoride varnish |
4,433 |
4,152 |
$92K |
| D1120 |
Prophylaxis - child |
2,180 |
2,104 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
864 |
502 |
$63K |
| D2394 |
|
535 |
365 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
760 |
380 |
$46K |
| D9222 |
|
594 |
545 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,343 |
3,782 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
354 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
545 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
807 |
639 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
329 |
120 |
$25K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
68 |
36 |
$24K |
| D0330 |
Panoramic radiographic image |
401 |
292 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
76 |
13 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
133 |
133 |
$10K |
| D2950 |
|
85 |
63 |
$5K |
| D2791 |
|
13 |
12 |
$5K |
| D2332 |
|
26 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
83 |
$1K |
| D9110 |
|
21 |
15 |
$175.50 |
| D1999 |
|
1,382 |
1,036 |
$0.00 |