| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
5,950 |
2,022 |
$1.24M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,654 |
2,571 |
$1.09M |
| D2931 |
|
6,381 |
1,771 |
$840K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,240 |
798 |
$698K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,263 |
1,413 |
$508K |
| D7230 |
|
2,678 |
1,170 |
$499K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,052 |
1,279 |
$375K |
| D0330 |
Panoramic radiographic image |
8,933 |
7,813 |
$365K |
| D0140 |
Limited oral evaluation - problem focused |
9,500 |
8,282 |
$341K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,492 |
1,164 |
$330K |
| D2335 |
|
2,085 |
497 |
$251K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,386 |
963 |
$241K |
| D7241 |
|
596 |
318 |
$166K |
| D2394 |
|
486 |
159 |
$79K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
28 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,938 |
820 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,216 |
$14K |
| D0270 |
|
1,564 |
1,492 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
100 |
$6K |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$183.77 |
| D9999 |
Unspecified adjunctive procedure, by report |
4,300 |
3,853 |
$0.21 |