| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,719 |
2,701 |
$155K |
| D1120 |
Prophylaxis - child |
2,808 |
2,782 |
$115K |
| D7240 |
Removal of impacted tooth - completely bony |
424 |
173 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
647 |
322 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,217 |
3,148 |
$64K |
| D0330 |
Panoramic radiographic image |
1,615 |
1,592 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,585 |
2,558 |
$39K |
| D1310 |
|
630 |
624 |
$28K |
| D1110 |
Prophylaxis - adult |
265 |
265 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
316 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,679 |
1,669 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
428 |
425 |
$16K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
53 |
43 |
$13K |
| D9430 |
|
409 |
408 |
$13K |
| D9993 |
|
161 |
161 |
$9K |
| D7230 |
|
47 |
27 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
163 |
163 |
$8K |
| D9221 |
|
31 |
28 |
$7K |
| D9220 |
|
28 |
28 |
$7K |
| D0603 |
|
375 |
369 |
$5K |
| D9222 |
|
41 |
41 |
$5K |
| D0274 |
Bitewings - four radiographic images |
202 |
201 |
$4K |
| D1351 |
Sealant - per tooth |
159 |
39 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
26 |
$2K |
| D1999 |
|
43 |
43 |
$0.00 |