| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,963 |
8,361 |
$221K |
| D1110 |
Prophylaxis - adult |
4,279 |
3,913 |
$192K |
| D0272 |
Bitewings - two radiographic images |
7,581 |
7,128 |
$168K |
| D1120 |
Prophylaxis - child |
5,053 |
4,839 |
$167K |
| D1206 |
Topical application of fluoride varnish |
6,575 |
6,336 |
$120K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
860 |
332 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,373 |
851 |
$106K |
| D0250 |
|
1,787 |
1,738 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,161 |
325 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,815 |
2,593 |
$70K |
| D8670 |
Periodic orthodontic treatment visit |
610 |
145 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,403 |
2,970 |
$58K |
| D2140 |
|
853 |
556 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,245 |
2,015 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
491 |
446 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,223 |
1,004 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,562 |
2,286 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
508 |
291 |
$33K |
| D1351 |
Sealant - per tooth |
1,139 |
347 |
$31K |
| D0330 |
Panoramic radiographic image |
762 |
708 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
173 |
$14K |
| D2160 |
|
151 |
102 |
$14K |
| D7111 |
|
251 |
152 |
$12K |
| D0601 |
|
1,839 |
1,761 |
$9K |
| D0602 |
|
1,783 |
1,710 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
134 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
12 |
$4K |
| D0603 |
|
606 |
574 |
$3K |
| D2331 |
|
15 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
55 |
53 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
23 |
12 |
$959.70 |
| D9222 |
|
16 |
12 |
$863.75 |