| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45,814 |
30,890 |
$2.47M |
| D7140 |
Extraction, erupted tooth or exposed root |
57,131 |
23,460 |
$2.38M |
| D1110 |
Prophylaxis - adult |
85,995 |
83,362 |
$2.29M |
| D0210 |
Intraoral - complete series of radiographic images |
38,568 |
37,300 |
$1.68M |
| D1206 |
Topical application of fluoride varnish |
130,539 |
126,303 |
$1.66M |
| D0120 |
Periodic oral evaluation - established patient |
103,131 |
99,505 |
$1.46M |
| D0140 |
Limited oral evaluation - problem focused |
56,463 |
54,997 |
$1.11M |
| D0274 |
Bitewings - four radiographic images |
54,376 |
52,461 |
$917K |
| D1120 |
Prophylaxis - child |
44,293 |
42,530 |
$915K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,969 |
13,031 |
$803K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34,188 |
32,878 |
$682K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,453 |
7,444 |
$616K |
| D1351 |
Sealant - per tooth |
35,155 |
7,825 |
$581K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,845 |
951 |
$426K |
| D0220 |
Intraoral - periapical first radiographic image |
48,364 |
46,868 |
$393K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,889 |
1,396 |
$242K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,136 |
1,795 |
$182K |
| D0330 |
Panoramic radiographic image |
4,469 |
4,400 |
$170K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,461 |
2,276 |
$144K |
| D7240 |
Removal of impacted tooth - completely bony |
877 |
369 |
$140K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,295 |
575 |
$115K |
| D9222 |
|
1,875 |
1,788 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,335 |
2,193 |
$98K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,787 |
2,221 |
$93K |
| D7230 |
|
538 |
298 |
$78K |
| D0272 |
Bitewings - two radiographic images |
6,201 |
5,960 |
$77K |
| D2331 |
|
1,426 |
1,019 |
$70K |
| H0022 |
Alcohol and/or drug intervention service (planned facilitation) |
6,238 |
3,084 |
$68K |
| D9420 |
|
236 |
228 |
$43K |
| D2330 |
|
971 |
486 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,323 |
1,640 |
$31K |
| Q3014 |
Telehealth originating site facility fee |
1,646 |
1,248 |
$30K |
| D2335 |
|
433 |
268 |
$29K |
| D2394 |
|
344 |
284 |
$27K |
| D1354 |
|
2,994 |
822 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
623 |
442 |
$24K |
| D2332 |
|
323 |
237 |
$19K |
| D5110 |
|
50 |
24 |
$11K |
| D7220 |
|
102 |
50 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
779 |
737 |
$9K |
| D2140 |
|
283 |
216 |
$9K |
| D0270 |
|
990 |
984 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
408 |
209 |
$6K |
| 90834 |
Psychotherapy, 45 minutes with patient |
221 |
89 |
$6K |
| 90832 |
Psychotherapy, 30 minutes with patient |
86 |
60 |
$4K |
| D2940 |
|
120 |
87 |
$3K |
| D9110 |
|
96 |
95 |
$2K |
| D2931 |
|
31 |
24 |
$2K |
| 90837 |
Psychotherapy, 53 minutes with patient |
30 |
15 |
$2K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
132 |
43 |
$2K |
| D4355 |
|
25 |
25 |
$2K |
| D4910 |
|
26 |
24 |
$1K |
| D2160 |
|
19 |
16 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
13 |
$181.66 |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
28 |
13 |
$120.83 |
| D7999Z |
|
16 |
13 |
$0.00 |
| D5899 |
|
21,174 |
14,288 |
$0.00 |
| D5899Z |
|
1,437 |
904 |
$0.00 |
| D9999Z |
|
19 |
15 |
$0.00 |