| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,340 |
397 |
$234K |
| D9243 |
|
1,032 |
638 |
$218K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
359 |
298 |
$161K |
| D9248 |
|
1,751 |
1,606 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,690 |
1,602 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
427 |
154 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,404 |
1,292 |
$37K |
| D2394 |
|
420 |
292 |
$37K |
| D9239 |
|
600 |
562 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,776 |
2,548 |
$24K |
| D0330 |
Panoramic radiographic image |
1,253 |
1,169 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
89 |
$10K |
| D3310 |
|
21 |
12 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,785 |
2,389 |
$6K |
| D2335 |
|
22 |
12 |
$3K |
| D1999 |
|
216 |
188 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D9612 |
|
35 |
34 |
$2K |