| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
208 |
201 |
$129K |
| D9920 |
|
220 |
183 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
473 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
151 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
169 |
$15K |
| D1110 |
Prophylaxis - adult |
341 |
319 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
95 |
$11K |
| D0274 |
Bitewings - four radiographic images |
270 |
251 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
261 |
241 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
131 |
38 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
14 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
344 |
327 |
$5K |
| D1120 |
Prophylaxis - child |
243 |
234 |
$5K |
| D0330 |
Panoramic radiographic image |
74 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
232 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
47 |
$3K |
| D9222 |
|
42 |
38 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
96 |
91 |
$2K |
| D0272 |
Bitewings - two radiographic images |
84 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
76 |
38 |
$732.48 |
| D1351 |
Sealant - per tooth |
37 |
13 |
$462.40 |