| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,419 |
449 |
$320K |
| D5130 |
|
423 |
393 |
$221K |
| D0140 |
Limited oral evaluation - problem focused |
6,209 |
5,418 |
$209K |
| D5110 |
|
455 |
412 |
$206K |
| D0330 |
Panoramic radiographic image |
3,649 |
3,277 |
$183K |
| D5140 |
|
400 |
357 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,344 |
3,294 |
$135K |
| D2954 |
|
757 |
414 |
$116K |
| D5120 |
|
257 |
233 |
$107K |
| D1110 |
Prophylaxis - adult |
1,978 |
1,833 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
4,833 |
4,273 |
$67K |
| D1120 |
Prophylaxis - child |
1,887 |
1,703 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
519 |
239 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,235 |
2,017 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,675 |
2,426 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,610 |
1,488 |
$46K |
| D4341 |
|
227 |
75 |
$34K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
41 |
$32K |
| D2750 |
|
54 |
40 |
$31K |
| D0274 |
Bitewings - four radiographic images |
834 |
784 |
$26K |
| D2394 |
|
125 |
77 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
28 |
$15K |
| D0180 |
|
293 |
293 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
172 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
339 |
190 |
$9K |
| D0272 |
Bitewings - two radiographic images |
121 |
117 |
$3K |
| D2332 |
|
28 |
12 |
$2K |
| D4910 |
|
27 |
24 |
$1K |
| D0350 |
|
41 |
39 |
$767.50 |
| D1320 |
|
12 |
12 |
$382.44 |
| D9986 |
|
445 |
427 |
$0.00 |
| D9987 |
|
41 |
40 |
$0.00 |