| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,372 |
5,302 |
$277K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,325 |
3,266 |
$123K |
| D0272 |
Bitewings - two radiographic images |
7,600 |
7,468 |
$49K |
| D0330 |
Panoramic radiographic image |
3,157 |
3,083 |
$22K |
| D1351 |
Sealant - per tooth |
3,967 |
1,174 |
$21K |
| D1120 |
Prophylaxis - child |
3,268 |
3,229 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
560 |
442 |
$14K |
| D1330 |
|
5,351 |
5,280 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,325 |
8,130 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
8,816 |
8,650 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,026 |
4,959 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
93 |
$10K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,179 |
$8K |
| D9310 |
|
185 |
164 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
102 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
622 |
594 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
75 |
$4K |
| D0601 |
|
395 |
395 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$1K |
| D4355 |
|
62 |
60 |
$993.50 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$908.88 |
| D0340 |
|
42 |
38 |
$734.65 |
| D8660 |
|
29 |
24 |
$391.12 |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
14 |
$280.00 |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$155.99 |
| D0274 |
Bitewings - four radiographic images |
40 |
38 |
$0.00 |