| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,590 |
27,429 |
$645K |
| D1110 |
Prophylaxis - adult |
14,295 |
14,200 |
$627K |
| D1206 |
Topical application of fluoride varnish |
28,527 |
28,346 |
$523K |
| D1120 |
Prophylaxis - child |
12,698 |
12,623 |
$410K |
| D0274 |
Bitewings - four radiographic images |
12,876 |
12,775 |
$385K |
| D7240 |
Removal of impacted tooth - completely bony |
1,178 |
355 |
$320K |
| D1351 |
Sealant - per tooth |
6,335 |
2,735 |
$219K |
| D2140 |
|
2,069 |
1,618 |
$181K |
| D0272 |
Bitewings - two radiographic images |
8,060 |
7,994 |
$168K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,486 |
1,102 |
$156K |
| D0330 |
Panoramic radiographic image |
2,644 |
2,622 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
677 |
309 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,603 |
2,457 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,986 |
1,963 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
575 |
460 |
$77K |
| D4346 |
|
1,523 |
1,518 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
582 |
460 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
2,943 |
2,928 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
806 |
798 |
$27K |
| D1353 |
|
705 |
379 |
$25K |
| D7111 |
|
386 |
298 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
839 |
837 |
$21K |
| D9243 |
|
59 |
58 |
$15K |
| D9310 |
|
356 |
354 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
21 |
19 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
230 |
$7K |
| D9239 |
|
59 |
58 |
$6K |
| D0240 |
|
177 |
175 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
135 |
135 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$4K |
| D8660 |
|
18 |
18 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
12 |
$2K |
| D9222 |
|
20 |
19 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D0350 |
|
47 |
47 |
$1K |
| D9219 |
|
19 |
19 |
$592.65 |