| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,224 |
3,292 |
$270K |
| D8670 |
Periodic orthodontic treatment visit |
1,626 |
1,624 |
$249K |
| D0330 |
Panoramic radiographic image |
9,748 |
9,728 |
$238K |
| D9310 |
|
3,384 |
3,384 |
$150K |
| D9243 |
|
824 |
815 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
6,200 |
6,197 |
$60K |
| D1120 |
Prophylaxis - child |
1,632 |
1,632 |
$53K |
| D7261 |
|
245 |
233 |
$46K |
| D9239 |
|
770 |
766 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,119 |
3,109 |
$31K |
| D0340 |
|
757 |
756 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,280 |
1,280 |
$28K |
| D8660 |
|
806 |
806 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
453 |
362 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,426 |
1,426 |
$18K |
| D1206 |
Topical application of fluoride varnish |
754 |
753 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,177 |
2,175 |
$12K |
| D0350 |
|
855 |
854 |
$9K |
| D7230 |
|
72 |
72 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
698 |
697 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
16 |
13 |
$4K |
| D1354 |
|
111 |
41 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12 |
12 |
$890.38 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$828.95 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$635.04 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$538.88 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$251.30 |
| D0170 |
|
113 |
113 |
$0.00 |
| D0171 |
|
268 |
261 |
$0.00 |
| D1999 |
|
255 |
248 |
$0.00 |