| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9243 |
|
1,049 |
200 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
641 |
187 |
$71K |
| D1110 |
Prophylaxis - adult |
1,517 |
1,488 |
$58K |
| D7311 |
|
692 |
201 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,580 |
1,552 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
176 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,955 |
1,857 |
$29K |
| D0330 |
Panoramic radiographic image |
637 |
616 |
$26K |
| D0274 |
Bitewings - four radiographic images |
808 |
787 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
496 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,153 |
1,124 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,569 |
1,119 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
462 |
$17K |
| D9239 |
|
210 |
199 |
$15K |
| D9110 |
|
286 |
278 |
$12K |
| D1120 |
Prophylaxis - child |
294 |
289 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
25 |
$5K |
| D7250 |
|
40 |
15 |
$5K |
| D9610 |
|
108 |
90 |
$3K |
| D9986 |
|
32 |
31 |
$0.00 |