| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,178 |
1,170 |
$412K |
| D0210 |
Intraoral - complete series of radiographic images |
18,889 |
15,832 |
$407K |
| D7240 |
Removal of impacted tooth - completely bony |
1,003 |
369 |
$396K |
| D1110 |
Prophylaxis - adult |
13,492 |
10,135 |
$277K |
| D0140 |
Limited oral evaluation - problem focused |
18,656 |
15,819 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,587 |
9,031 |
$139K |
| D9995 |
|
8,598 |
7,353 |
$136K |
| D4341 |
|
5,290 |
1,357 |
$134K |
| D7999 |
|
595 |
307 |
$53K |
| D8670 |
Periodic orthodontic treatment visit |
764 |
637 |
$40K |
| D1206 |
Topical application of fluoride varnish |
22,329 |
17,244 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,010 |
424 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
763 |
260 |
$26K |
| D0274 |
Bitewings - four radiographic images |
4,163 |
2,850 |
$22K |
| D7230 |
|
92 |
50 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
11,672 |
8,882 |
$11K |
| D4346 |
|
264 |
243 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
752 |
192 |
$6K |
| D1120 |
Prophylaxis - child |
433 |
279 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,264 |
3,526 |
$3K |
| D4342 |
|
287 |
56 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,418 |
880 |
$2K |
| D4266 |
|
23 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
68 |
65 |
$2K |
| D1351 |
Sealant - per tooth |
264 |
48 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D7311 |
|
84 |
68 |
$486.12 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$437.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$165.77 |
| D0250 |
|
56 |
56 |
$106.08 |
| D1999 |
|
1,744 |
1,575 |
$0.00 |
| D4921 |
|
916 |
296 |
$0.00 |
| D0270 |
|
61 |
61 |
$0.00 |
| D0431 |
|
18 |
18 |
$0.00 |
| D9630 |
|
434 |
380 |
$0.00 |
| D1330 |
|
24 |
16 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
18 |
$0.00 |