| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,918 |
19,656 |
$521K |
| D1120 |
Prophylaxis - child |
16,748 |
16,421 |
$464K |
| D1110 |
Prophylaxis - adult |
6,515 |
6,420 |
$251K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,622 |
599 |
$244K |
| D1206 |
Topical application of fluoride varnish |
12,992 |
12,734 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,599 |
8,506 |
$146K |
| D7240 |
Removal of impacted tooth - completely bony |
713 |
224 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,942 |
2,807 |
$128K |
| D0272 |
Bitewings - two radiographic images |
5,855 |
5,752 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,192 |
3,133 |
$98K |
| D0160 |
|
1,351 |
1,320 |
$90K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,099 |
748 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,881 |
1,796 |
$84K |
| D0330 |
Panoramic radiographic image |
1,361 |
1,333 |
$64K |
| D9222 |
|
823 |
784 |
$57K |
| D1351 |
Sealant - per tooth |
1,903 |
521 |
$53K |
| D9612 |
|
714 |
684 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
398 |
162 |
$41K |
| D0240 |
|
2,404 |
1,289 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
233 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
693 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,199 |
1,161 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
122 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
118 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
828 |
351 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
129 |
122 |
$5K |
| D9248 |
|
409 |
371 |
$4K |
| D7230 |
|
20 |
13 |
$3K |
| D9610 |
|
49 |
48 |
$2K |
| D1354 |
|
57 |
14 |
$352.11 |