| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
124 |
45 |
$25K |
| D7230 |
|
133 |
58 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
140 |
72 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
420 |
407 |
$15K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
86 |
86 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
204 |
78 |
$14K |
| D9612 |
|
197 |
197 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
402 |
239 |
$11K |
| D0330 |
Panoramic radiographic image |
365 |
255 |
$10K |
| D9243 |
|
95 |
95 |
$8K |
| D9239 |
|
99 |
99 |
$8K |
| D9222 |
|
86 |
86 |
$6K |
| D1110 |
Prophylaxis - adult |
252 |
146 |
$6K |
| D0274 |
Bitewings - four radiographic images |
184 |
105 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
168 |
103 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
98 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
85 |
$1K |
| D1120 |
Prophylaxis - child |
50 |
27 |
$739.96 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$566.16 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$293.56 |