| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,198 |
710 |
$276K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,890 |
659 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,154 |
3,139 |
$208K |
| D7240 |
Removal of impacted tooth - completely bony |
476 |
175 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,169 |
2,159 |
$103K |
| D1110 |
Prophylaxis - adult |
1,055 |
1,053 |
$91K |
| D9222 |
|
722 |
711 |
$85K |
| D0350 |
|
6,463 |
1,651 |
$61K |
| D9430 |
|
1,875 |
1,590 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
375 |
375 |
$30K |
| D1320 |
|
1,824 |
1,824 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,550 |
1,541 |
$25K |
| D0330 |
Panoramic radiographic image |
731 |
731 |
$22K |
| D1120 |
Prophylaxis - child |
359 |
359 |
$17K |
| D9610 |
|
765 |
754 |
$16K |
| D7230 |
|
64 |
36 |
$12K |
| D0274 |
Bitewings - four radiographic images |
278 |
278 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
53 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,359 |
741 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
374 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$873.60 |