| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,683 |
932 |
$256K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,390 |
2,220 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,675 |
1,584 |
$203K |
| D7230 |
|
1,064 |
747 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
4,671 |
4,325 |
$73K |
| D0330 |
Panoramic radiographic image |
2,369 |
2,234 |
$41K |
| D9243 |
|
444 |
270 |
$28K |
| D1120 |
Prophylaxis - child |
568 |
533 |
$23K |
| D1351 |
Sealant - per tooth |
471 |
144 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
703 |
638 |
$17K |
| D9239 |
|
329 |
267 |
$12K |
| D7220 |
|
145 |
115 |
$10K |
| D1206 |
Topical application of fluoride varnish |
373 |
367 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
395 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
270 |
245 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
159 |
$5K |
| D0274 |
Bitewings - four radiographic images |
235 |
218 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
27 |
23 |
$3K |
| D9222 |
|
24 |
23 |
$3K |
| D7310 |
|
39 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
18 |
$2K |
| D0272 |
Bitewings - two radiographic images |
130 |
128 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
145 |
$834.40 |
| D9310 |
|
47 |
46 |
$769.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$586.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
56 |
$513.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$381.00 |
| D9610 |
|
23 |
23 |
$351.97 |
| D9612 |
|
16 |
16 |
$14.64 |
| D7921 |
|
17 |
17 |
$0.00 |
| D1330 |
|
176 |
173 |
$0.00 |