| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7230 |
|
1,845 |
889 |
$384K |
| D7240 |
Removal of impacted tooth - completely bony |
521 |
275 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,228 |
1,196 |
$30K |
| D0330 |
Panoramic radiographic image |
760 |
760 |
$30K |
| D7250 |
|
263 |
161 |
$26K |
| D9310 |
|
1,342 |
1,334 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
287 |
204 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
296 |
290 |
$13K |
| D1110 |
Prophylaxis - adult |
137 |
137 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
173 |
$4K |
| D2954 |
|
18 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
140 |
140 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
265 |
264 |
$1K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
188 |
$1K |
| D0603 |
|
17 |
17 |
$170.00 |