| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,519 |
656 |
$349K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,096 |
4,086 |
$253K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,325 |
706 |
$154K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
537 |
364 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
2,113 |
2,105 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,422 |
1,416 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
999 |
478 |
$67K |
| D0330 |
Panoramic radiographic image |
2,236 |
2,232 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,289 |
3,417 |
$57K |
| D9220 |
|
243 |
243 |
$56K |
| D9221 |
|
325 |
244 |
$56K |
| D9430 |
|
1,559 |
1,429 |
$50K |
| D4910 |
|
580 |
576 |
$45K |
| D9222 |
|
365 |
365 |
$44K |
| D1120 |
Prophylaxis - child |
1,358 |
1,355 |
$44K |
| D7230 |
|
208 |
129 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,819 |
1,809 |
$38K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
82 |
73 |
$38K |
| D0350 |
|
3,670 |
940 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,081 |
1,073 |
$16K |
| D9610 |
|
450 |
325 |
$14K |
| D1110 |
Prophylaxis - adult |
148 |
148 |
$12K |
| D1320 |
|
715 |
715 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
718 |
$9K |
| D4341 |
|
101 |
28 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
781 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
31 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
157 |
156 |
$2K |
| D0270 |
|
351 |
344 |
$2K |