| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,663 |
10,493 |
$244K |
| D1120 |
Prophylaxis - child |
6,406 |
5,546 |
$183K |
| D1110 |
Prophylaxis - adult |
5,712 |
4,190 |
$163K |
| D1206 |
Topical application of fluoride varnish |
11,807 |
9,172 |
$157K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,764 |
516 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,387 |
1,307 |
$98K |
| D1351 |
Sealant - per tooth |
5,223 |
1,036 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
4,403 |
2,261 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
382 |
93 |
$47K |
| D0272 |
Bitewings - two radiographic images |
3,005 |
2,253 |
$46K |
| D2140 |
|
950 |
443 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
393 |
182 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,777 |
1,565 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
975 |
673 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,253 |
818 |
$11K |
| D0330 |
Panoramic radiographic image |
258 |
202 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
257 |
192 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
47 |
$889.20 |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$691.60 |
| D0603 |
|
75 |
75 |
$330.00 |
| D0601 |
|
106 |
84 |
$250.29 |
| D0602 |
|
74 |
43 |
$140.00 |
| D1330 |
|
566 |
463 |
$0.00 |
| D9420 |
|
272 |
245 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18 |
14 |
$0.00 |
| D1310 |
|
181 |
148 |
$0.00 |
| 41899 |
Unlisted procedure, dentoalveolar structures |
192 |
14 |
$0.00 |
| D0170 |
|
558 |
65 |
$0.00 |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
14 |
12 |
$0.00 |
| D0191 |
|
31 |
12 |
$0.00 |
| 99188 |
|
17 |
14 |
$0.00 |