| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,468 |
3,917 |
$992K |
| D9243 |
|
6,541 |
3,663 |
$431K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,435 |
1,430 |
$381K |
| D9239 |
|
4,066 |
3,894 |
$283K |
| D7230 |
|
1,238 |
656 |
$216K |
| D7240 |
Removal of impacted tooth - completely bony |
1,038 |
421 |
$193K |
| D0330 |
Panoramic radiographic image |
4,064 |
4,008 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
3,595 |
3,534 |
$88K |
| D7220 |
|
594 |
372 |
$76K |
| D1110 |
Prophylaxis - adult |
1,641 |
1,631 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
725 |
447 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,852 |
1,841 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
574 |
$24K |
| D1120 |
Prophylaxis - child |
892 |
883 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,108 |
1,061 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
958 |
950 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,630 |
1,623 |
$20K |
| D9310 |
|
782 |
767 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,964 |
2,390 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
222 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,037 |
2,979 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
36 |
28 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
103 |
74 |
$9K |
| D0272 |
Bitewings - two radiographic images |
518 |
511 |
$5K |
| D1206 |
Topical application of fluoride varnish |
279 |
250 |
$5K |
| D2950 |
|
54 |
47 |
$5K |
| D1999 |
|
676 |
643 |
$4K |
| D4341 |
|
35 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
54 |
43 |
$1K |
| D2332 |
|
17 |
12 |
$1K |