| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,614 |
723 |
$366K |
| D7240 |
Removal of impacted tooth - completely bony |
1,107 |
364 |
$226K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,840 |
774 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,033 |
3,820 |
$145K |
| D9222 |
|
1,642 |
1,533 |
$134K |
| D0330 |
Panoramic radiographic image |
2,768 |
2,611 |
$125K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,145 |
757 |
$124K |
| D1120 |
Prophylaxis - child |
408 |
403 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
665 |
655 |
$16K |
| 70355 |
|
883 |
782 |
$14K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
499 |
410 |
$11K |
| 70350 |
|
708 |
626 |
$10K |
| D1206 |
Topical application of fluoride varnish |
617 |
609 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
85 |
68 |
$5K |
| D1110 |
Prophylaxis - adult |
69 |
68 |
$3K |
| D9239 |
|
41 |
36 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
54 |
50 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
21 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$822.36 |
| D9610 |
|
15 |
15 |
$416.14 |
| 99024 |
|
511 |
338 |
$0.00 |