| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,767 |
6,396 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,645 |
3,573 |
$205K |
| D1120 |
Prophylaxis - child |
4,861 |
4,579 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
3,363 |
3,276 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,895 |
8,006 |
$119K |
| D0274 |
Bitewings - four radiographic images |
5,883 |
5,602 |
$78K |
| D0350 |
|
12,067 |
4,232 |
$77K |
| D1110 |
Prophylaxis - adult |
996 |
977 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,256 |
4,988 |
$63K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
323 |
115 |
$33K |
| D1351 |
Sealant - per tooth |
1,512 |
315 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
217 |
$22K |
| D9430 |
|
773 |
747 |
$21K |
| D4341 |
|
363 |
134 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
162 |
$13K |
| D0330 |
Panoramic radiographic image |
1,085 |
1,049 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
13 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
53 |
53 |
$7K |
| D9220 |
|
24 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
596 |
$4K |
| D0272 |
Bitewings - two radiographic images |
410 |
394 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
63 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
36 |
$3K |
| D2140 |
|
51 |
24 |
$2K |
| D9310 |
|
26 |
26 |
$1K |
| D1310 |
|
38 |
38 |
$1K |
| D9993 |
|
26 |
26 |
$1K |
| D4910 |
|
13 |
12 |
$757.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
14 |
12 |
$734.10 |
| D1320 |
|
26 |
26 |
$412.50 |
| D0603 |
|
12 |
12 |
$228.00 |
| D0270 |
|
42 |
41 |
$166.00 |
| D1330 |
|
451 |
394 |
$0.00 |