| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
4,854 |
4,809 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
856 |
567 |
$123K |
| D1110 |
Prophylaxis - adult |
1,914 |
1,903 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,549 |
3,501 |
$90K |
| D7240 |
Removal of impacted tooth - completely bony |
190 |
133 |
$82K |
| D9310 |
|
913 |
904 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,814 |
1,796 |
$47K |
| D0330 |
Panoramic radiographic image |
2,104 |
2,064 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,834 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
2,302 |
2,129 |
$38K |
| D1120 |
Prophylaxis - child |
884 |
881 |
$37K |
| D1351 |
Sealant - per tooth |
528 |
183 |
$33K |
| D2750 |
|
35 |
29 |
$30K |
| D2954 |
|
161 |
133 |
$29K |
| D9110 |
|
860 |
839 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,746 |
1,711 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
957 |
954 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
83 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
65 |
$10K |
| D1206 |
Topical application of fluoride varnish |
196 |
195 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
26 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
33 |
$3K |
| D9222 |
|
38 |
38 |
$2K |
| D3320 |
|
15 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
28 |
$1K |
| D0340 |
|
28 |
27 |
$1K |
| D7310 |
|
17 |
17 |
$1K |
| D8660 |
|
36 |
36 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
72 |
$1K |
| D0470 |
|
15 |
15 |
$540.00 |
| D0350 |
|
15 |
15 |
$210.00 |
| D1330 |
|
13 |
13 |
$0.00 |