| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,475 |
4,420 |
$112K |
| D1120 |
Prophylaxis - child |
3,396 |
3,355 |
$91K |
| D1206 |
Topical application of fluoride varnish |
4,657 |
4,604 |
$74K |
| D0160 |
|
683 |
670 |
$45K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,144 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
236 |
65 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
699 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,054 |
1,036 |
$17K |
| D0274 |
Bitewings - four radiographic images |
448 |
439 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
263 |
249 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
28 |
$11K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
61 |
47 |
$9K |
| D0330 |
Panoramic radiographic image |
223 |
219 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
44 |
13 |
$8K |
| D0240 |
|
456 |
228 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
363 |
354 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
24 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
76 |
$3K |
| D9222 |
|
43 |
41 |
$3K |
| D2950 |
|
26 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
148 |
$2K |
| D9612 |
|
18 |
18 |
$1K |
| D9248 |
|
59 |
53 |
$889.84 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$413.41 |