| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,684 |
2,148 |
$498K |
| D0330 |
Panoramic radiographic image |
5,668 |
5,608 |
$298K |
| D0140 |
Limited oral evaluation - problem focused |
8,862 |
8,075 |
$274K |
| D9243 |
|
1,000 |
191 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
6,623 |
5,978 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
828 |
523 |
$57K |
| D2140 |
|
843 |
324 |
$56K |
| D7953 |
|
132 |
40 |
$54K |
| D0364 |
|
43 |
43 |
$47K |
| D2161 |
|
378 |
217 |
$47K |
| D9239 |
|
219 |
191 |
$43K |
| D2160 |
|
406 |
245 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,438 |
2,121 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,099 |
1,094 |
$40K |
| D0367 |
|
48 |
48 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,098 |
1,090 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
314 |
189 |
$30K |
| D1206 |
Topical application of fluoride varnish |
325 |
325 |
$9K |
| D1110 |
Prophylaxis - adult |
170 |
170 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
37 |
$6K |
| D0270 |
|
653 |
638 |
$5K |
| D2950 |
|
13 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
66 |
66 |
$2K |
| D0460 |
|
104 |
101 |
$2K |
| D1120 |
Prophylaxis - child |
37 |
37 |
$2K |
| D9110 |
|
35 |
35 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$663.41 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
18 |
$333.69 |
| D0171 |
|
19 |
13 |
$0.00 |
| D9215 |
|
90 |
82 |
$0.00 |
| D9987 |
|
14 |
13 |
$0.00 |