| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,543 |
3,462 |
$1.43M |
| D9310 |
|
4,601 |
4,595 |
$537K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,037 |
877 |
$440K |
| D9239 |
|
3,342 |
3,319 |
$354K |
| D9243 |
|
1,788 |
1,778 |
$292K |
| D7240 |
Removal of impacted tooth - completely bony |
327 |
258 |
$272K |
| D0330 |
Panoramic radiographic image |
3,441 |
3,440 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
90 |
$21K |
| D1120 |
Prophylaxis - child |
265 |
264 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
302 |
302 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
31 |
$11K |
| D5110 |
|
12 |
12 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
53 |
53 |
$9K |
| D9610 |
|
406 |
405 |
$8K |
| D1351 |
Sealant - per tooth |
55 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
187 |
$6K |
| D9222 |
|
60 |
60 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
257 |
256 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
233 |
$5K |
| D7230 |
|
13 |
13 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
132 |
$4K |
| D2331 |
|
12 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
54 |
54 |
$2K |
| D9995 |
|
86 |
86 |
$2K |
| D0272 |
Bitewings - two radiographic images |
57 |
57 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$1K |