| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
7,193 |
6,980 |
$221K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,802 |
1,071 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,712 |
1,627 |
$210K |
| D1110 |
Prophylaxis - adult |
2,467 |
2,443 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,623 |
2,609 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
2,576 |
2,551 |
$139K |
| D0330 |
Panoramic radiographic image |
2,803 |
2,796 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,913 |
4,376 |
$35K |
| D4910 |
|
430 |
428 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
551 |
551 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,126 |
1,112 |
$13K |
| D0274 |
Bitewings - four radiographic images |
597 |
596 |
$13K |
| D3221 |
|
137 |
131 |
$8K |
| D1120 |
Prophylaxis - child |
132 |
131 |
$4K |
| D1206 |
Topical application of fluoride varnish |
243 |
242 |
$4K |
| D2940 |
|
45 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
121 |
121 |
$1K |
| D1310 |
|
13 |
13 |
$0.00 |