| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7250 |
|
6,274 |
1,179 |
$574K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,583 |
1,857 |
$522K |
| D7230 |
|
585 |
297 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,050 |
4,036 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
3,843 |
3,262 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,547 |
4,524 |
$44K |
| D7240 |
Removal of impacted tooth - completely bony |
135 |
79 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,539 |
1,170 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
443 |
77 |
$28K |
| D1110 |
Prophylaxis - adult |
612 |
566 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,122 |
1,073 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
561 |
526 |
$10K |
| D4342 |
|
84 |
25 |
$5K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$938.56 |