| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
2,497 |
793 |
$750K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,685 |
1,456 |
$703K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,681 |
737 |
$282K |
| D9243 |
|
3,150 |
1,754 |
$183K |
| D0140 |
Limited oral evaluation - problem focused |
5,287 |
4,794 |
$178K |
| D9239 |
|
2,106 |
1,879 |
$125K |
| D0330 |
Panoramic radiographic image |
1,168 |
1,086 |
$65K |
| D1110 |
Prophylaxis - adult |
1,478 |
1,383 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,012 |
1,893 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,083 |
2,148 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,669 |
1,542 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,300 |
2,135 |
$22K |
| D0272 |
Bitewings - two radiographic images |
881 |
827 |
$18K |
| D7230 |
|
66 |
30 |
$17K |
| D7310 |
|
79 |
26 |
$16K |
| D1120 |
Prophylaxis - child |
608 |
560 |
$14K |
| D0274 |
Bitewings - four radiographic images |
374 |
342 |
$12K |
| D7250 |
|
55 |
12 |
$11K |
| D1351 |
Sealant - per tooth |
279 |
53 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
181 |
$6K |
| D2940 |
|
69 |
50 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
15 |
$3K |
| D7311 |
|
15 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
41 |
$1K |
| D4212 |
|
21 |
15 |
$798.12 |
| D1206 |
Topical application of fluoride varnish |
15 |
14 |
$344.24 |
| D2161 |
|
20 |
14 |
$232.54 |
| D0240 |
|
21 |
12 |
$148.00 |
| D3221 |
|
15 |
12 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
21 |
16 |
$0.00 |