| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,850 |
3,832 |
$229K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
719 |
481 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
3,523 |
3,490 |
$162K |
| D1351 |
Sealant - per tooth |
5,580 |
1,364 |
$138K |
| D8670 |
Periodic orthodontic treatment visit |
578 |
568 |
$137K |
| D1120 |
Prophylaxis - child |
4,039 |
3,998 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,352 |
5,451 |
$98K |
| D1110 |
Prophylaxis - adult |
1,098 |
1,096 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,685 |
3,647 |
$63K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
503 |
307 |
$62K |
| D9222 |
|
494 |
479 |
$62K |
| D7240 |
Removal of impacted tooth - completely bony |
218 |
101 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,225 |
1,220 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,002 |
3,965 |
$46K |
| D0330 |
Panoramic radiographic image |
1,197 |
1,191 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
43 |
$25K |
| D9430 |
|
687 |
663 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
184 |
$18K |
| D7230 |
|
81 |
48 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
123 |
$13K |
| D9220 |
|
50 |
50 |
$12K |
| D9221 |
|
83 |
50 |
$10K |
| D0272 |
Bitewings - two radiographic images |
509 |
506 |
$6K |
| D2954 |
|
53 |
40 |
$5K |
| D4910 |
|
55 |
55 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
728 |
$3K |
| D4341 |
|
43 |
13 |
$2K |
| D1330 |
|
56 |
55 |
$0.00 |
| D1999 |
|
46 |
46 |
$0.00 |