| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
3,626 |
1,268 |
$693K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,684 |
4,924 |
$638K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,350 |
16,323 |
$569K |
| D1120 |
Prophylaxis - child |
17,463 |
17,448 |
$555K |
| D0274 |
Bitewings - four radiographic images |
17,858 |
17,821 |
$522K |
| D9243 |
|
4,799 |
2,093 |
$405K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,755 |
3,584 |
$374K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,586 |
17,566 |
$320K |
| D1110 |
Prophylaxis - adult |
5,718 |
5,704 |
$249K |
| D0140 |
Limited oral evaluation - problem focused |
6,117 |
6,016 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
7,826 |
7,819 |
$175K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,549 |
625 |
$171K |
| D9239 |
|
1,366 |
1,350 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,493 |
1,120 |
$166K |
| D7230 |
|
754 |
403 |
$124K |
| D0272 |
Bitewings - two radiographic images |
6,085 |
6,078 |
$124K |
| D0330 |
Panoramic radiographic image |
2,743 |
2,734 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,286 |
7,977 |
$91K |
| D9610 |
|
1,907 |
1,888 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
838 |
780 |
$23K |
| D1351 |
Sealant - per tooth |
462 |
115 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,070 |
1,047 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
36 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
52 |
$1K |