| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
6,161 |
2,054 |
$891K |
| D9243 |
|
7,780 |
2,487 |
$488K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,756 |
1,231 |
$265K |
| D0140 |
Limited oral evaluation - problem focused |
6,922 |
6,429 |
$148K |
| D7230 |
|
1,182 |
608 |
$140K |
| D9239 |
|
2,645 |
2,440 |
$128K |
| D9612 |
|
2,893 |
2,672 |
$114K |
| D7220 |
|
1,117 |
598 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,582 |
662 |
$90K |
| D0330 |
Panoramic radiographic image |
4,459 |
4,159 |
$79K |
| D1110 |
Prophylaxis - adult |
2,073 |
1,990 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,429 |
887 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,322 |
2,234 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,662 |
2,548 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,852 |
4,500 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
978 |
573 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
446 |
328 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
682 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,784 |
1,694 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,577 |
3,318 |
$13K |
| D1999 |
|
920 |
797 |
$11K |
| D1120 |
Prophylaxis - child |
476 |
444 |
$10K |
| D0272 |
Bitewings - two radiographic images |
950 |
909 |
$8K |
| D7250 |
|
142 |
54 |
$8K |
| D2332 |
|
69 |
40 |
$4K |
| D1206 |
Topical application of fluoride varnish |
142 |
140 |
$3K |
| D2330 |
|
77 |
50 |
$2K |
| D2394 |
|
34 |
29 |
$2K |
| D4341 |
|
80 |
27 |
$2K |
| D2331 |
|
17 |
12 |
$403.34 |
| D9992 |
|
22 |
21 |
$330.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| D4265 |
|
21 |
19 |
$0.00 |