| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,657 |
6,284 |
$201K |
| D1110 |
Prophylaxis - adult |
3,955 |
3,913 |
$190K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,164 |
958 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,425 |
1,268 |
$170K |
| D7240 |
Removal of impacted tooth - completely bony |
890 |
448 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
4,552 |
4,506 |
$135K |
| D7230 |
|
846 |
459 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,350 |
3,316 |
$112K |
| D1206 |
Topical application of fluoride varnish |
4,136 |
4,098 |
$107K |
| D0330 |
Panoramic radiographic image |
1,402 |
1,383 |
$73K |
| D7220 |
|
300 |
167 |
$44K |
| D9222 |
|
346 |
338 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
597 |
390 |
$36K |
| D1120 |
Prophylaxis - child |
1,111 |
1,109 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,583 |
2,522 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,187 |
$32K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
409 |
357 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
187 |
$24K |
| D0272 |
Bitewings - two radiographic images |
422 |
421 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
128 |
$9K |
| D3320 |
|
17 |
16 |
$8K |
| D1351 |
Sealant - per tooth |
197 |
44 |
$6K |
| D2140 |
|
172 |
110 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
603 |
587 |
$3K |
| D2940 |
|
36 |
30 |
$2K |
| D2331 |
|
18 |
12 |
$2K |
| D2160 |
|
14 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
78 |
$898.92 |
| D9110 |
|
12 |
12 |
$535.56 |
| D4910 |
|
25 |
24 |
$275.84 |
| D0270 |
|
12 |
12 |
$160.32 |
| D1999 |
|
1,271 |
1,099 |
$46.53 |
| D9995 |
|
145 |
145 |
$0.00 |
| D9310 |
|
15 |
14 |
$0.00 |