| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,031 |
383 |
$106K |
| D9243 |
|
1,471 |
439 |
$46K |
| D9239 |
|
462 |
439 |
$30K |
| D0367 |
|
279 |
264 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,166 |
1,059 |
$24K |
| D9612 |
|
441 |
403 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
287 |
92 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
442 |
$11K |
| D0330 |
Panoramic radiographic image |
467 |
433 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
159 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
15 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
66 |
$6K |
| D0250 |
|
414 |
413 |
$6K |
| D1110 |
Prophylaxis - adult |
132 |
130 |
$4K |
| D7230 |
|
26 |
14 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
204 |
204 |
$3K |
| D9610 |
|
429 |
391 |
$3K |
| D1206 |
Topical application of fluoride varnish |
171 |
171 |
$3K |
| D0274 |
Bitewings - four radiographic images |
130 |
129 |
$2K |
| D1120 |
Prophylaxis - child |
68 |
66 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
266 |
254 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
299 |
80 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |