| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,672 |
1,421 |
$717K |
| D0210 |
Intraoral - complete series of radiographic images |
3,030 |
2,340 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,223 |
2,533 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,289 |
278 |
$90K |
| D7250 |
|
539 |
161 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,060 |
493 |
$71K |
| D2949 |
|
401 |
202 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,233 |
1,054 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
455 |
228 |
$37K |
| D0330 |
Panoramic radiographic image |
832 |
759 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
39 |
$25K |
| D3320 |
|
46 |
25 |
$17K |
| D1110 |
Prophylaxis - adult |
400 |
289 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
317 |
130 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
986 |
839 |
$12K |
| D2335 |
|
96 |
37 |
$11K |
| D2332 |
|
91 |
45 |
$9K |
| D5110 |
|
18 |
14 |
$8K |
| D5120 |
|
17 |
13 |
$7K |
| D2331 |
|
89 |
31 |
$6K |
| D4346 |
|
50 |
43 |
$6K |
| D0274 |
Bitewings - four radiographic images |
213 |
189 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
602 |
420 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
241 |
175 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
46 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$736.83 |
| D1206 |
Topical application of fluoride varnish |
19 |
15 |
$264.80 |
| D0431 |
|
149 |
126 |
$0.00 |
| D0460 |
|
13 |
12 |
$0.00 |