| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
498 |
147 |
$57K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
785 |
171 |
$44K |
| D9222 |
|
202 |
169 |
$15K |
| D9310 |
|
329 |
302 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
219 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
731 |
253 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
210 |
$7K |
| D1110 |
Prophylaxis - adult |
162 |
149 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
419 |
373 |
$5K |
| D9610 |
|
167 |
138 |
$3K |
| D9219 |
|
172 |
139 |
$3K |
| D0274 |
Bitewings - four radiographic images |
70 |
66 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$780.36 |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$308.00 |