| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,009 |
7,928 |
$356K |
| D1120 |
Prophylaxis - child |
7,911 |
7,828 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,716 |
3,662 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,397 |
10,445 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,376 |
727 |
$170K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
593 |
376 |
$134K |
| D1206 |
Topical application of fluoride varnish |
9,492 |
9,390 |
$128K |
| D1110 |
Prophylaxis - adult |
1,642 |
1,609 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,477 |
2,443 |
$89K |
| D7240 |
Removal of impacted tooth - completely bony |
368 |
164 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,170 |
687 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,184 |
781 |
$68K |
| D1351 |
Sealant - per tooth |
2,402 |
594 |
$62K |
| D8670 |
Periodic orthodontic treatment visit |
228 |
228 |
$61K |
| D0272 |
Bitewings - two radiographic images |
5,023 |
4,966 |
$50K |
| D9222 |
|
380 |
376 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
915 |
628 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,615 |
2,594 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
346 |
133 |
$41K |
| D7230 |
|
171 |
93 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
723 |
714 |
$28K |
| D2140 |
|
575 |
390 |
$28K |
| D9430 |
|
1,052 |
1,025 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
240 |
94 |
$24K |
| D4341 |
|
376 |
146 |
$22K |
| D1310 |
|
479 |
474 |
$21K |
| D9610 |
|
475 |
325 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,105 |
1,019 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
68 |
68 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
14 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
81 |
$8K |
| D0603 |
|
477 |
472 |
$7K |
| D2160 |
|
76 |
55 |
$6K |
| D0350 |
|
682 |
426 |
$6K |
| D0330 |
Panoramic radiographic image |
163 |
163 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
93 |
$3K |
| D4910 |
|
12 |
12 |
$715.00 |
| D1999 |
|
795 |
732 |
$270.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$252.00 |
| D1330 |
|
6,751 |
6,610 |
$0.00 |