| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
7,278 |
7,128 |
$196K |
| D1110 |
Prophylaxis - adult |
3,868 |
3,823 |
$195K |
| D0330 |
Panoramic radiographic image |
4,261 |
4,162 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,737 |
4,676 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,633 |
2,592 |
$71K |
| D1120 |
Prophylaxis - child |
1,855 |
1,834 |
$71K |
| D9310 |
|
659 |
659 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
338 |
$47K |
| D1351 |
Sealant - per tooth |
628 |
219 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
389 |
139 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
600 |
576 |
$29K |
| D1206 |
Topical application of fluoride varnish |
975 |
970 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,148 |
2,046 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
155 |
$23K |
| D2394 |
|
149 |
119 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,673 |
1,663 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
167 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,364 |
1,193 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
521 |
509 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
137 |
$12K |
| D2332 |
|
63 |
45 |
$7K |
| D9222 |
|
39 |
37 |
$5K |
| D9110 |
|
223 |
222 |
$5K |
| D1310 |
|
327 |
325 |
$3K |
| D1330 |
|
322 |
317 |
$3K |
| D2335 |
|
24 |
12 |
$3K |
| D7310 |
|
30 |
25 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
26 |
24 |
$2K |
| D0340 |
|
42 |
41 |
$2K |
| D0470 |
|
39 |
39 |
$1K |
| D4341 |
|
32 |
13 |
$1K |
| D0350 |
|
28 |
27 |
$397.60 |