| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,052 |
700 |
$50K |
| D9243 |
|
474 |
151 |
$34K |
| D9239 |
|
194 |
171 |
$20K |
| D7250 |
|
129 |
38 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
305 |
183 |
$2K |
| D0330 |
Panoramic radiographic image |
1,273 |
1,140 |
$2K |
| D1354 |
|
30,366 |
1,647 |
$695.64 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,002 |
1,793 |
$231.12 |
| D1355 |
|
24,241 |
1,278 |
$192.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,239 |
1,015 |
$175.98 |
| D0191 |
|
3,032 |
2,673 |
$116.76 |
| D1110 |
Prophylaxis - adult |
240 |
233 |
$84.34 |
| D0603 |
|
4,484 |
3,822 |
$84.32 |
| D0272 |
Bitewings - two radiographic images |
371 |
362 |
$81.10 |
| D1320 |
|
2,051 |
1,829 |
$66.50 |
| D1321 |
|
1,184 |
1,038 |
$35.00 |
| D1206 |
Topical application of fluoride varnish |
1,401 |
1,281 |
$34.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
586 |
297 |
$19.46 |
| D1330 |
|
7,154 |
5,993 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,168 |
952 |
$0.00 |
| D1310 |
|
2,634 |
2,302 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
400 |
322 |
$0.00 |
| D9995 |
|
402 |
352 |
$0.00 |
| D0601 |
|
815 |
729 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
26 |
$0.00 |
| D0602 |
|
81 |
76 |
$0.00 |
| D0240 |
|
24 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
247 |
234 |
$0.00 |
| D9920 |
|
47 |
37 |
$0.00 |
| D4999 |
|
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
569 |
528 |
$0.00 |
| D1120 |
Prophylaxis - child |
61 |
59 |
$0.00 |
| D9996 |
|
164 |
163 |
$0.00 |
| D4341 |
|
30 |
13 |
$0.00 |
| D0270 |
|
15 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
60 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
21 |
21 |
$0.00 |