| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,436 |
2,521 |
$425K |
| D0330 |
Panoramic radiographic image |
7,355 |
6,726 |
$256K |
| D0140 |
Limited oral evaluation - problem focused |
10,095 |
9,286 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
5,529 |
4,963 |
$184K |
| D1110 |
Prophylaxis - adult |
6,846 |
6,379 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,524 |
1,430 |
$169K |
| D2954 |
|
1,597 |
1,332 |
$148K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
549 |
460 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,744 |
4,384 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,048 |
3,810 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,448 |
3,232 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,332 |
3,127 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
992 |
783 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,380 |
4,518 |
$35K |
| D1120 |
Prophylaxis - child |
1,390 |
1,298 |
$30K |
| D3320 |
|
135 |
112 |
$27K |
| D2140 |
|
623 |
414 |
$18K |
| D7220 |
|
113 |
69 |
$10K |
| D2791 |
|
60 |
41 |
$7K |
| D0272 |
Bitewings - two radiographic images |
478 |
450 |
$6K |
| D5110 |
|
13 |
13 |
$6K |
| D4355 |
|
60 |
58 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
38 |
38 |
$3K |
| D7250 |
|
32 |
17 |
$2K |
| D2160 |
|
17 |
17 |
$899.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$59.33 |