| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,383 |
4,772 |
$1.10M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,758 |
6,732 |
$431K |
| D7240 |
Removal of impacted tooth - completely bony |
1,120 |
502 |
$258K |
| D0330 |
Panoramic radiographic image |
6,415 |
6,391 |
$190K |
| D7230 |
|
428 |
248 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
175 |
$28K |
| D0350 |
|
2,294 |
601 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
339 |
339 |
$16K |
| D1110 |
Prophylaxis - adult |
180 |
180 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
31 |
24 |
$15K |
| D7220 |
|
97 |
53 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
78 |
$13K |
| D9430 |
|
285 |
284 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,142 |
393 |
$5K |
| D1206 |
Topical application of fluoride varnish |
182 |
182 |
$3K |
| D2954 |
|
13 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$1K |
| D4910 |
|
12 |
12 |
$847.00 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$528.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$390.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$231.00 |