| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,903 |
2,869 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,230 |
2,190 |
$130K |
| D1120 |
Prophylaxis - child |
2,404 |
2,380 |
$88K |
| D1110 |
Prophylaxis - adult |
1,134 |
1,116 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
247 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,616 |
1,591 |
$65K |
| D9430 |
|
3,046 |
2,503 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
355 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,161 |
3,860 |
$39K |
| D0330 |
Panoramic radiographic image |
1,594 |
1,581 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,450 |
1,433 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,252 |
1,238 |
$22K |
| D4921 |
|
91 |
54 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
1,005 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,190 |
1,162 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
98 |
$8K |
| D4999 |
|
107 |
66 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
32 |
13 |
$6K |
| D9310 |
|
89 |
87 |
$4K |
| D9986 |
|
64 |
59 |
$4K |
| D0340 |
|
74 |
74 |
$3K |
| D4910 |
|
12 |
12 |
$2K |
| D0270 |
|
159 |
155 |
$664.50 |
| D1999 |
|
151 |
109 |
$320.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$198.00 |