| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9310 |
|
8,974 |
8,973 |
$345K |
| D0330 |
Panoramic radiographic image |
9,066 |
9,062 |
$219K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
367 |
355 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,240 |
1,052 |
$92K |
| D1110 |
Prophylaxis - adult |
2,353 |
2,353 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,859 |
3,859 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,295 |
2,295 |
$46K |
| D1120 |
Prophylaxis - child |
1,261 |
1,261 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,361 |
4,302 |
$38K |
| D9110 |
|
1,516 |
1,515 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
2,413 |
2,371 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,405 |
1,405 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,939 |
2,921 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
93 |
$10K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
235 |
234 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
26 |
26 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
201 |
201 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
38 |
$2K |
| D8660 |
|
100 |
100 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
62 |
$1K |
| D0340 |
|
63 |
63 |
$912.99 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$838.70 |
| D9430 |
|
26 |
24 |
$367.60 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$292.30 |
| D0350 |
|
60 |
60 |
$205.08 |
| 99072 |
|
210 |
209 |
$0.00 |