| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,862 |
6,771 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,957 |
3,911 |
$227K |
| D7240 |
Removal of impacted tooth - completely bony |
985 |
414 |
$220K |
| D1120 |
Prophylaxis - child |
5,164 |
5,102 |
$141K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
776 |
675 |
$118K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
776 |
372 |
$97K |
| D9222 |
|
717 |
707 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,386 |
7,539 |
$64K |
| D4341 |
|
959 |
382 |
$54K |
| D1206 |
Topical application of fluoride varnish |
5,321 |
5,256 |
$52K |
| D0274 |
Bitewings - four radiographic images |
3,954 |
3,913 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,217 |
1,205 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
559 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,060 |
670 |
$44K |
| D1110 |
Prophylaxis - adult |
1,001 |
987 |
$39K |
| D9430 |
|
3,177 |
2,887 |
$35K |
| D7230 |
|
176 |
97 |
$34K |
| D0330 |
Panoramic radiographic image |
978 |
971 |
$30K |
| D1351 |
Sealant - per tooth |
989 |
213 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
397 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,317 |
3,005 |
$16K |
| D2140 |
|
424 |
309 |
$16K |
| D0272 |
Bitewings - two radiographic images |
2,253 |
2,215 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
990 |
980 |
$13K |
| D9248 |
|
149 |
145 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
17 |
$3K |
| D9220 |
|
49 |
49 |
$1K |
| D2160 |
|
28 |
25 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D9221 |
|
52 |
47 |
$624.96 |
| D0350 |
|
53 |
25 |
$508.80 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$344.40 |
| D1999 |
|
216 |
195 |
$130.00 |
| D1330 |
|
2,617 |
2,552 |
$0.00 |