| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,890 |
4,029 |
$1.04M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,366 |
8,357 |
$495K |
| D7230 |
|
2,597 |
1,639 |
$484K |
| D7240 |
Removal of impacted tooth - completely bony |
2,026 |
1,131 |
$463K |
| D0330 |
Panoramic radiographic image |
6,322 |
6,309 |
$180K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
365 |
345 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,024 |
2,021 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,445 |
500 |
$82K |
| D9430 |
|
1,687 |
1,627 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,027 |
3,070 |
$27K |
| D3320 |
|
54 |
47 |
$19K |
| D3310 |
|
26 |
17 |
$8K |
| D4341 |
|
108 |
42 |
$7K |
| D1110 |
Prophylaxis - adult |
59 |
59 |
$5K |
| D0274 |
Bitewings - four radiographic images |
183 |
182 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
29 |
$3K |
| D4910 |
|
42 |
42 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
117 |
117 |
$3K |
| D0350 |
|
491 |
214 |
$3K |
| D3221 |
|
42 |
40 |
$3K |
| D2140 |
|
26 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$1K |
| D4342 |
|
32 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
72 |
71 |
$781.50 |
| D0270 |
|
46 |
46 |
$222.50 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$216.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$132.00 |