| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,231 |
14,780 |
$62K |
| D1120 |
Prophylaxis - child |
8,787 |
8,448 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,779 |
1,683 |
$25K |
| D1206 |
Topical application of fluoride varnish |
18,482 |
17,997 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,068 |
4,326 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,767 |
11,473 |
$15K |
| D1351 |
Sealant - per tooth |
2,281 |
642 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,784 |
1,685 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
246 |
229 |
$6K |
| D0274 |
Bitewings - four radiographic images |
10,103 |
9,880 |
$6K |
| D1110 |
Prophylaxis - adult |
11,257 |
11,031 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
5,958 |
5,746 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,951 |
2,650 |
$4K |
| D0330 |
Panoramic radiographic image |
5,871 |
5,730 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
2,523 |
2,479 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
16,707 |
15,699 |
$1K |
| D5110 |
|
962 |
962 |
$799.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,749 |
11,020 |
$687.84 |
| D0240 |
|
923 |
452 |
$285.12 |
| D1999 |
|
19 |
16 |
$133.00 |
| D0601 |
|
1,464 |
1,422 |
$10.00 |
| D9248 |
|
757 |
691 |
$0.00 |
| D0603 |
|
2,265 |
2,206 |
$0.00 |
| D9310 |
|
3,846 |
3,823 |
$0.00 |
| D1330 |
|
551 |
514 |
$0.00 |
| D1310 |
|
358 |
353 |
$0.00 |
| D7230 |
|
374 |
269 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,630 |
1,189 |
$0.00 |
| D5751 |
|
110 |
110 |
$0.00 |
| D0602 |
|
1,858 |
1,839 |
$0.00 |
| D5750 |
|
187 |
187 |
$0.00 |
| D0801 |
|
48 |
48 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
430 |
189 |
$0.00 |
| D5120 |
|
592 |
592 |
$0.00 |
| D5851 |
|
696 |
693 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
83 |
27 |
$0.00 |
| D7471 |
|
297 |
169 |
$0.00 |
| D5410 |
|
80 |
76 |
$0.00 |
| D5999 |
|
390 |
367 |
$0.00 |
| D5130 |
|
13 |
13 |
$0.00 |
| D4342 |
|
132 |
71 |
$0.00 |
| D9222 |
|
27 |
27 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
39 |
39 |
$0.00 |
| D2335 |
|
21 |
13 |
$0.00 |
| D2330 |
|
19 |
12 |
$0.00 |
| D7250 |
|
92 |
26 |
$0.00 |
| D2331 |
|
34 |
25 |
$0.00 |
| D9612 |
|
27 |
27 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,191 |
2,453 |
$0.00 |
| D4341 |
|
136 |
51 |
$0.00 |
| D0270 |
|
321 |
314 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,094 |
1,286 |
$0.00 |
| D5850 |
|
885 |
867 |
$0.00 |
| D4910 |
|
1,005 |
979 |
$0.00 |
| D8660 |
|
1,129 |
1,005 |
$0.00 |
| D2332 |
|
225 |
104 |
$0.00 |
| D9430 |
|
403 |
398 |
$0.00 |
| D0180 |
|
151 |
151 |
$0.00 |
| D5211 |
|
28 |
28 |
$0.00 |
| D9990 |
|
51 |
46 |
$0.00 |
| D3320 |
|
29 |
25 |
$0.00 |
| D5411 |
|
28 |
26 |
$0.00 |
| D4921 |
|
35 |
12 |
$0.00 |
| D2394 |
|
12 |
12 |
$0.00 |