| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
668 |
241 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
707 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
596 |
552 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
47 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
472 |
389 |
$2K |
| D1206 |
Topical application of fluoride varnish |
234 |
227 |
$968.26 |
| D0140 |
Limited oral evaluation - problem focused |
160 |
147 |
$894.30 |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
375 |
$755.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
435 |
198 |
$534.48 |
| D0274 |
Bitewings - four radiographic images |
190 |
155 |
$532.33 |
| D2954 |
|
15 |
12 |
$389.79 |
| D1110 |
Prophylaxis - adult |
17 |
16 |
$150.03 |
| D9222 |
|
15 |
15 |
$128.78 |
| D0120 |
Periodic oral evaluation - established patient |
32 |
29 |
$109.44 |