| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13,647 |
5,967 |
$1.59M |
| D7240 |
Removal of impacted tooth - completely bony |
4,075 |
1,857 |
$907K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,446 |
10,412 |
$683K |
| D7230 |
|
2,481 |
1,543 |
$460K |
| D0330 |
Panoramic radiographic image |
9,659 |
9,625 |
$287K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,859 |
747 |
$106K |
| D9430 |
|
2,197 |
2,074 |
$70K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
138 |
129 |
$64K |
| D1320 |
|
4,015 |
4,015 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,180 |
1,180 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,088 |
1,061 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
492 |
216 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,268 |
2,258 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
155 |
$16K |
| D0350 |
|
1,348 |
492 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
44 |
44 |
$4K |
| D7283 |
|
16 |
12 |
$3K |
| D7280 |
|
18 |
14 |
$2K |
| D0270 |
|
375 |
371 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$480.00 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$456.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$229.50 |