| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,008 |
1,663 |
$349K |
| D8670 |
Periodic orthodontic treatment visit |
1,192 |
1,192 |
$280K |
| D1110 |
Prophylaxis - adult |
5,730 |
5,730 |
$233K |
| D9243 |
|
1,051 |
1,022 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
7,042 |
7,041 |
$157K |
| D0274 |
Bitewings - four radiographic images |
6,703 |
6,703 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,591 |
871 |
$111K |
| D0330 |
Panoramic radiographic image |
3,323 |
3,323 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,102 |
7,099 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
8,080 |
8,071 |
$76K |
| D9310 |
|
1,866 |
1,866 |
$73K |
| D9239 |
|
1,054 |
1,033 |
$64K |
| D7240 |
Removal of impacted tooth - completely bony |
87 |
71 |
$49K |
| D0340 |
|
981 |
981 |
$43K |
| D8660 |
|
880 |
879 |
$25K |
| D1120 |
Prophylaxis - child |
659 |
659 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,706 |
1,705 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
194 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
247 |
$17K |
| D0160 |
|
394 |
394 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
545 |
545 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
209 |
120 |
$15K |
| D1351 |
Sealant - per tooth |
278 |
88 |
$13K |
| D0350 |
|
1,093 |
1,093 |
$12K |
| D2954 |
|
43 |
25 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
3,197 |
3,192 |
$4K |
| D1206 |
Topical application of fluoride varnish |
138 |
138 |
$3K |
| D9430 |
|
61 |
58 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
74 |
$698.15 |