| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26,986 |
13,673 |
$4.11M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,291 |
4,919 |
$1.09M |
| D0140 |
Limited oral evaluation - problem focused |
30,948 |
27,950 |
$1.06M |
| D0330 |
Panoramic radiographic image |
12,316 |
11,286 |
$675K |
| D7240 |
Removal of impacted tooth - completely bony |
1,851 |
913 |
$550K |
| D7230 |
|
1,035 |
723 |
$270K |
| D2335 |
|
1,314 |
780 |
$199K |
| D0220 |
Intraoral - periapical first radiographic image |
16,693 |
15,138 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
4,576 |
3,645 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,827 |
1,089 |
$130K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,146 |
820 |
$99K |
| D7310 |
|
710 |
241 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,244 |
2,084 |
$87K |
| D2394 |
|
868 |
651 |
$87K |
| D0270 |
|
3,698 |
3,427 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,068 |
585 |
$61K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
179 |
152 |
$48K |
| D1110 |
Prophylaxis - adult |
918 |
853 |
$46K |
| D7220 |
|
252 |
176 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,775 |
2,637 |
$33K |
| D5110 |
|
143 |
131 |
$32K |
| D9248 |
|
1,339 |
1,199 |
$26K |
| D4346 |
|
134 |
122 |
$20K |
| D3320 |
|
46 |
37 |
$18K |
| D4341 |
|
86 |
25 |
$13K |
| D2332 |
|
82 |
52 |
$10K |
| D1351 |
Sealant - per tooth |
314 |
39 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
307 |
280 |
$7K |
| D5120 |
|
28 |
26 |
$7K |
| D0274 |
Bitewings - four radiographic images |
252 |
231 |
$7K |
| D1206 |
Topical application of fluoride varnish |
480 |
445 |
$5K |
| D7311 |
|
93 |
42 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
162 |
155 |
$3K |
| D0272 |
Bitewings - two radiographic images |
32 |
27 |
$843.48 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$310.50 |
| D7111 |
|
18 |
13 |
$72.25 |
| D0180 |
|
288 |
273 |
$0.00 |
| D9215 |
|
18 |
17 |
$0.00 |