| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
1,068 |
1,012 |
$589K |
| D5120 |
|
704 |
664 |
$397K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,435 |
324 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
3,063 |
2,945 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,148 |
1,997 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,727 |
2,648 |
$54K |
| D0330 |
Panoramic radiographic image |
1,772 |
1,681 |
$45K |
| D1110 |
Prophylaxis - adult |
1,340 |
1,303 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,534 |
2,437 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
244 |
$26K |
| D1120 |
Prophylaxis - child |
896 |
847 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,669 |
2,478 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
608 |
104 |
$17K |
| D1999 |
|
1,353 |
1,053 |
$16K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
124 |
47 |
$14K |
| D0274 |
Bitewings - four radiographic images |
929 |
898 |
$10K |
| D7310 |
|
59 |
26 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
59 |
16 |
$8K |
| D5750 |
|
47 |
47 |
$7K |
| D5751 |
|
31 |
30 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,656 |
1,916 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
43 |
$4K |
| D9222 |
|
47 |
45 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$113.19 |