| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,094 |
5,770 |
$147K |
| D1110 |
Prophylaxis - adult |
2,935 |
2,785 |
$127K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,165 |
675 |
$85K |
| D1120 |
Prophylaxis - child |
2,164 |
2,038 |
$72K |
| D8670 |
Periodic orthodontic treatment visit |
626 |
344 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,821 |
2,669 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,519 |
2,458 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,437 |
2,275 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,977 |
1,744 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
579 |
547 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
985 |
920 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,878 |
1,655 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,361 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
63 |
$21K |
| D2140 |
|
235 |
167 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
51 |
12 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
104 |
78 |
$9K |
| D9222 |
|
69 |
66 |
$6K |
| D0601 |
|
1,009 |
970 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
79 |
$3K |
| D2160 |
|
28 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
123 |
117 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
111 |
$2K |
| D0602 |
|
179 |
174 |
$875.95 |
| D0603 |
|
136 |
133 |
$650.83 |