| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,474 |
497 |
$219K |
| D5110 |
|
529 |
281 |
$188K |
| D5120 |
|
464 |
246 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,685 |
242 |
$105K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,103 |
340 |
$96K |
| D7240 |
Removal of impacted tooth - completely bony |
439 |
93 |
$70K |
| D7250 |
|
872 |
109 |
$60K |
| D7310 |
|
440 |
77 |
$32K |
| D9243 |
|
484 |
115 |
$26K |
| D9222 |
|
517 |
314 |
$25K |
| D0330 |
Panoramic radiographic image |
627 |
359 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
735 |
411 |
$12K |
| D9239 |
|
194 |
126 |
$10K |
| D5211 |
|
28 |
13 |
$6K |
| D5212 |
|
17 |
12 |
$5K |
| D7220 |
|
57 |
16 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
159 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
104 |
$3K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$898.60 |
| D0120 |
Periodic oral evaluation - established patient |
21 |
21 |
$492.80 |
| D1206 |
Topical application of fluoride varnish |
19 |
19 |
$405.90 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$246.00 |