| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
19,978 |
8,419 |
$1.13M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,414 |
10,396 |
$655K |
| D0120 |
Periodic oral evaluation - established patient |
8,999 |
8,986 |
$493K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,059 |
2,338 |
$477K |
| D9430 |
|
15,243 |
14,643 |
$469K |
| D0210 |
Intraoral - complete series of radiographic images |
7,563 |
7,547 |
$351K |
| D0330 |
Panoramic radiographic image |
11,365 |
11,310 |
$330K |
| D1120 |
Prophylaxis - child |
8,117 |
8,087 |
$305K |
| D7240 |
Removal of impacted tooth - completely bony |
1,164 |
648 |
$266K |
| D1110 |
Prophylaxis - adult |
2,727 |
2,718 |
$232K |
| D7230 |
|
1,153 |
617 |
$216K |
| D4910 |
|
2,439 |
2,435 |
$180K |
| D1206 |
Topical application of fluoride varnish |
12,294 |
12,262 |
$175K |
| D0170 |
|
2,238 |
2,195 |
$160K |
| D0160 |
|
1,458 |
1,448 |
$141K |
| D1351 |
Sealant - per tooth |
4,137 |
1,609 |
$115K |
| D0274 |
Bitewings - four radiographic images |
6,592 |
6,575 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,448 |
12,259 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,402 |
2,210 |
$92K |
| D2940 |
|
1,107 |
992 |
$66K |
| D3221 |
|
1,025 |
980 |
$63K |
| D9243 |
|
1,903 |
1,122 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,458 |
4,396 |
$52K |
| D9239 |
|
1,141 |
1,137 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
450 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
516 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,558 |
2,552 |
$30K |
| D0270 |
|
5,875 |
5,620 |
$27K |
| D9242 |
|
632 |
408 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
344 |
344 |
$18K |
| D7220 |
|
93 |
59 |
$13K |
| D2330 |
|
117 |
86 |
$9K |
| D9241 |
|
148 |
147 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
329 |
328 |
$4K |
| D9248 |
|
63 |
54 |
$2K |
| D9110 |
|
12 |
12 |
$744.00 |
| D0190 |
|
443 |
432 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |