| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
609 |
190 |
$168K |
| D1110 |
Prophylaxis - adult |
1,526 |
1,473 |
$70K |
| D9243 |
|
250 |
249 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,433 |
1,403 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,204 |
1,134 |
$28K |
| D9239 |
|
259 |
257 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,734 |
1,638 |
$22K |
| D0350 |
|
532 |
422 |
$22K |
| D0274 |
Bitewings - four radiographic images |
421 |
391 |
$13K |
| D9310 |
|
314 |
309 |
$13K |
| D1351 |
Sealant - per tooth |
303 |
80 |
$11K |
| D1120 |
Prophylaxis - child |
313 |
308 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
225 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
560 |
$8K |
| D1206 |
Topical application of fluoride varnish |
347 |
328 |
$7K |
| D8660 |
|
25 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
48 |
$2K |
| D0340 |
|
26 |
26 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
53 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$754.05 |