| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
9,315 |
8,550 |
$682K |
| D4341 |
|
4,761 |
1,184 |
$277K |
| D9420 |
|
837 |
817 |
$243K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,423 |
1,390 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
7,524 |
7,402 |
$219K |
| D1110 |
Prophylaxis - adult |
5,314 |
5,237 |
$208K |
| D1206 |
Topical application of fluoride varnish |
2,288 |
2,238 |
$55K |
| D9995 |
|
2,693 |
2,206 |
$47K |
| D0191 |
|
2,578 |
2,106 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
157 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
449 |
438 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
582 |
$21K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
248 |
248 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
74 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
360 |
360 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
320 |
$9K |
| D0274 |
Bitewings - four radiographic images |
436 |
427 |
$8K |
| D9222 |
|
210 |
210 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,181 |
563 |
$6K |
| D0272 |
Bitewings - two radiographic images |
334 |
333 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
665 |
654 |
$5K |
| D0180 |
|
102 |
102 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$1K |
| D1999 |
|
21 |
21 |
$0.00 |