| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23,812 |
5,558 |
$1.84M |
| D9243 |
|
23,108 |
6,590 |
$974K |
| D7240 |
Removal of impacted tooth - completely bony |
3,882 |
1,629 |
$831K |
| D9239 |
|
7,252 |
7,003 |
$621K |
| D7230 |
|
2,838 |
1,405 |
$486K |
| D0367 |
|
4,806 |
4,653 |
$425K |
| D0140 |
Limited oral evaluation - problem focused |
8,684 |
8,252 |
$234K |
| D9612 |
|
5,573 |
5,403 |
$228K |
| D0330 |
Panoramic radiographic image |
4,755 |
4,593 |
$218K |
| D7310 |
|
1,090 |
349 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,090 |
416 |
$123K |
| D9610 |
|
5,242 |
4,891 |
$101K |
| D7250 |
|
271 |
69 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
860 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
38 |
$16K |
| D1110 |
Prophylaxis - adult |
429 |
413 |
$14K |
| D0274 |
Bitewings - four radiographic images |
486 |
472 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
514 |
501 |
$9K |
| D7220 |
|
56 |
31 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,237 |
1,178 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,052 |
871 |
$5K |
| D1206 |
Topical application of fluoride varnish |
248 |
247 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
75 |
74 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
52 |
$550.00 |
| D0350 |
|
30 |
29 |
$455.68 |