| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,400 |
435 |
$320K |
| D9243 |
|
2,097 |
832 |
$160K |
| D9239 |
|
839 |
803 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
377 |
180 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
912 |
$26K |
| D0330 |
Panoramic radiographic image |
829 |
808 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
61 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
342 |
331 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
288 |
$7K |
| D1120 |
Prophylaxis - child |
196 |
185 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
290 |
278 |
$5K |
| D1110 |
Prophylaxis - adult |
88 |
84 |
$3K |
| D0272 |
Bitewings - two radiographic images |
292 |
277 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$789.75 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$492.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$339.36 |