| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,060 |
8,015 |
$357K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,183 |
5,169 |
$315K |
| D0210 |
Intraoral - complete series of radiographic images |
4,692 |
4,680 |
$208K |
| D1120 |
Prophylaxis - child |
5,754 |
5,722 |
$182K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,948 |
8,589 |
$157K |
| D4341 |
|
2,227 |
875 |
$143K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
918 |
500 |
$109K |
| D0274 |
Bitewings - four radiographic images |
5,638 |
5,602 |
$98K |
| D1110 |
Prophylaxis - adult |
1,198 |
1,193 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,249 |
6,215 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
779 |
437 |
$52K |
| D1351 |
Sealant - per tooth |
2,081 |
458 |
$44K |
| D4910 |
|
600 |
598 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,194 |
1,193 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
154 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,385 |
1,370 |
$15K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
56 |
38 |
$13K |
| D9910 |
|
142 |
142 |
$8K |
| D1310 |
|
164 |
164 |
$7K |
| D9993 |
|
104 |
104 |
$7K |
| D9222 |
|
50 |
50 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
155 |
151 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
57 |
52 |
$5K |
| D2160 |
|
65 |
49 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
48 |
$5K |
| D0350 |
|
394 |
212 |
$4K |
| D2140 |
|
48 |
36 |
$3K |
| D4342 |
|
61 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$955.00 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
58 |
$686.00 |
| D9430 |
|
13 |
13 |
$416.00 |
| D1330 |
|
189 |
189 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
15 |
13 |
$0.00 |