| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,238 |
1,464 |
$365K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,160 |
2,127 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
2,268 |
2,247 |
$121K |
| D9430 |
|
3,380 |
3,205 |
$104K |
| D1120 |
Prophylaxis - child |
2,019 |
1,999 |
$71K |
| D1110 |
Prophylaxis - adult |
685 |
662 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
607 |
461 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,201 |
4,822 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
791 |
773 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,986 |
1,985 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
399 |
229 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,041 |
$21K |
| D0330 |
Panoramic radiographic image |
540 |
539 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,287 |
1,285 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
137 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
945 |
904 |
$9K |
| D0272 |
Bitewings - two radiographic images |
735 |
720 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
25 |
12 |
$6K |
| D7230 |
|
23 |
13 |
$4K |
| D4341 |
|
100 |
27 |
$4K |
| D9993 |
|
55 |
55 |
$2K |
| D1310 |
|
55 |
55 |
$2K |
| D1351 |
Sealant - per tooth |
102 |
20 |
$2K |
| D0270 |
|
211 |
201 |
$1K |
| D4910 |
|
12 |
12 |
$924.00 |
| D1330 |
|
2,349 |
2,347 |
$0.00 |
| D1999 |
|
28 |
27 |
$0.00 |
| D9110 |
|
40 |
26 |
$0.00 |