| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
22,607 |
3,078 |
$1.45M |
| D9243 |
|
11,122 |
3,683 |
$447K |
| D7230 |
|
2,126 |
953 |
$344K |
| D9239 |
|
4,073 |
3,853 |
$306K |
| D7310 |
|
1,544 |
532 |
$180K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,535 |
580 |
$173K |
| D0330 |
Panoramic radiographic image |
3,079 |
2,937 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
1,753 |
1,664 |
$39K |
| D7240 |
Removal of impacted tooth - completely bony |
82 |
39 |
$15K |
| D1110 |
Prophylaxis - adult |
185 |
175 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
266 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
119 |
$3K |
| D0274 |
Bitewings - four radiographic images |
86 |
83 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
60 |
60 |
$870.00 |
| D1120 |
Prophylaxis - child |
38 |
37 |
$720.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$135.00 |