| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
762 |
261 |
$42K |
| D0330 |
Panoramic radiographic image |
698 |
666 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
189 |
78 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
848 |
818 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
282 |
$17K |
| D1120 |
Prophylaxis - child |
329 |
324 |
$15K |
| D0274 |
Bitewings - four radiographic images |
595 |
572 |
$13K |
| D1206 |
Topical application of fluoride varnish |
344 |
336 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
75 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
302 |
$10K |
| D1351 |
Sealant - per tooth |
452 |
61 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
639 |
606 |
$9K |
| D9222 |
|
164 |
162 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
990 |
768 |
$8K |
| D8660 |
|
146 |
142 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
120 |
119 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
12 |
$5K |
| D9310 |
|
60 |
59 |
$4K |
| D7220 |
|
21 |
14 |
$2K |
| D0340 |
|
45 |
45 |
$2K |
| D0470 |
|
45 |
45 |
$1K |
| D0350 |
|
45 |
45 |
$894.89 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$893.68 |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$644.55 |