| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
63,941 |
60,116 |
$2.76M |
| D1120 |
Prophylaxis - child |
53,544 |
50,711 |
$1.83M |
| D1110 |
Prophylaxis - adult |
26,423 |
24,948 |
$1.49M |
| D9420 |
|
1,157 |
1,070 |
$1.36M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,516 |
10,319 |
$1.28M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,621 |
2,068 |
$815K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,319 |
7,383 |
$619K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,501 |
12,764 |
$550K |
| D1351 |
Sealant - per tooth |
46,157 |
11,590 |
$493K |
| D0210 |
Intraoral - complete series of radiographic images |
4,346 |
4,226 |
$452K |
| D7240 |
Removal of impacted tooth - completely bony |
5,739 |
1,711 |
$437K |
| D0330 |
Panoramic radiographic image |
16,358 |
15,432 |
$435K |
| D0272 |
Bitewings - two radiographic images |
44,206 |
41,809 |
$411K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,887 |
4,921 |
$403K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,542 |
13,245 |
$349K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,583 |
2,844 |
$339K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,826 |
1,289 |
$228K |
| D9222 |
|
2,332 |
2,064 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
76,192 |
71,673 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
6,407 |
5,910 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
838 |
421 |
$55K |
| D9920 |
|
8,178 |
7,441 |
$34K |
| D9310 |
|
1,103 |
1,045 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
79,898 |
75,579 |
$24K |
| D7283 |
|
50 |
31 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72,658 |
68,399 |
$14K |
| D2390 |
|
1,417 |
401 |
$13K |
| D1330 |
|
80,051 |
75,735 |
$13K |
| D0274 |
Bitewings - four radiographic images |
27,425 |
25,850 |
$13K |
| D7230 |
|
143 |
67 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,979 |
1,192 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
256 |
256 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
210 |
194 |
$4K |
| D3120 |
|
3,839 |
2,407 |
$4K |
| D1206 |
Topical application of fluoride varnish |
411 |
411 |
$3K |
| D1510 |
|
76 |
50 |
$3K |
| D1999 |
|
53 |
53 |
$2K |
| D7111 |
|
200 |
107 |
$2K |
| D7280 |
|
70 |
43 |
$2K |
| D9986 |
|
1,743 |
1,509 |
$1K |
| D9995 |
|
42 |
40 |
$1K |
| D0603 |
|
8,246 |
7,709 |
$840.65 |
| D1354 |
|
283 |
67 |
$794.45 |
| D2330 |
|
150 |
67 |
$238.56 |
| D9996 |
|
14 |
14 |
$178.78 |
| D0602 |
|
155 |
155 |
$159.72 |
| D0601 |
|
19 |
19 |
$15.00 |
| D8660 |
|
33 |
33 |
$0.00 |