| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,429 |
2,932 |
$754K |
| D7240 |
Removal of impacted tooth - completely bony |
2,304 |
844 |
$528K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,006 |
1,585 |
$341K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,963 |
4,950 |
$324K |
| D1110 |
Prophylaxis - adult |
3,093 |
3,075 |
$273K |
| D0210 |
Intraoral - complete series of radiographic images |
4,401 |
4,389 |
$208K |
| D9430 |
|
4,827 |
4,754 |
$154K |
| D1351 |
Sealant - per tooth |
3,418 |
543 |
$112K |
| D0330 |
Panoramic radiographic image |
3,835 |
3,810 |
$111K |
| D7230 |
|
532 |
324 |
$100K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
134 |
102 |
$63K |
| D0340 |
|
1,120 |
1,111 |
$54K |
| D1120 |
Prophylaxis - child |
1,332 |
1,325 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,087 |
3,066 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
462 |
303 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
377 |
377 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
369 |
228 |
$20K |
| D9243 |
|
491 |
269 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
503 |
503 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,583 |
2,443 |
$14K |
| D0274 |
Bitewings - four radiographic images |
758 |
754 |
$13K |
| D9239 |
|
276 |
276 |
$8K |
| D5140 |
|
12 |
12 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
68 |
$6K |
| D0270 |
|
1,281 |
1,273 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D4341 |
|
74 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
263 |
263 |
$3K |
| D2330 |
|
26 |
15 |
$2K |
| D2332 |
|
18 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |