| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,723 |
10,710 |
$405K |
| D0274 |
Bitewings - four radiographic images |
13,220 |
13,212 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
11,188 |
11,171 |
$241K |
| D1120 |
Prophylaxis - child |
4,642 |
4,631 |
$178K |
| D1351 |
Sealant - per tooth |
4,385 |
1,310 |
$173K |
| D8670 |
Periodic orthodontic treatment visit |
739 |
737 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,933 |
12,915 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,961 |
4,955 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
12,595 |
12,581 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,900 |
5,887 |
$77K |
| D0330 |
Panoramic radiographic image |
1,847 |
1,842 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
699 |
512 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
3,531 |
3,508 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
169 |
118 |
$9K |
| D0340 |
|
206 |
204 |
$8K |
| D0272 |
Bitewings - two radiographic images |
270 |
270 |
$4K |
| D0350 |
|
251 |
249 |
$3K |
| D9310 |
|
56 |
56 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
52 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
187 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
14 |
$2K |
| D8660 |
|
40 |
40 |
$1K |
| D9110 |
|
77 |
76 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$996.96 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
13 |
13 |
$952.20 |
| D9222 |
|
14 |
14 |
$717.58 |