| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41,351 |
9,983 |
$3.72M |
| D7240 |
Removal of impacted tooth - completely bony |
6,563 |
2,798 |
$1.04M |
| D7311 |
|
4,472 |
2,030 |
$747K |
| D0140 |
Limited oral evaluation - problem focused |
26,796 |
22,791 |
$655K |
| D7230 |
|
4,168 |
2,580 |
$591K |
| D7220 |
|
3,900 |
2,380 |
$403K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,296 |
1,921 |
$277K |
| D0330 |
Panoramic radiographic image |
17,641 |
15,853 |
$239K |
| D5110 |
|
396 |
262 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,461 |
4,850 |
$131K |
| D7310 |
|
708 |
295 |
$116K |
| D5120 |
|
144 |
135 |
$99K |
| D7250 |
|
1,188 |
389 |
$64K |
| D1110 |
Prophylaxis - adult |
1,057 |
975 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
597 |
322 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,845 |
1,719 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,051 |
1,015 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
877 |
772 |
$22K |
| D1999 |
|
1,960 |
1,486 |
$20K |
| D1120 |
Prophylaxis - child |
848 |
802 |
$17K |
| D2140 |
|
438 |
232 |
$17K |
| D2160 |
|
285 |
190 |
$15K |
| D1351 |
Sealant - per tooth |
683 |
148 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,696 |
1,561 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,020 |
929 |
$9K |
| D9930 |
|
176 |
136 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
237 |
220 |
$5K |
| D0272 |
Bitewings - two radiographic images |
475 |
455 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
33 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,688 |
1,444 |
$3K |
| D2331 |
|
62 |
42 |
$3K |
| D5410 |
|
14 |
14 |
$470.68 |