| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,063 |
528 |
$65K |
| D7230 |
|
308 |
150 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,477 |
1,437 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
293 |
124 |
$27K |
| D9222 |
|
113 |
113 |
$18K |
| D1120 |
Prophylaxis - child |
521 |
521 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
454 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
42 |
25 |
$12K |
| D1206 |
Topical application of fluoride varnish |
625 |
623 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
106 |
98 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
418 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
29 |
$5K |
| D0272 |
Bitewings - two radiographic images |
175 |
174 |
$4K |
| D0160 |
|
49 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
43 |
$941.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
12 |
$465.25 |
| D1999 |
|
417 |
349 |
$20.00 |