| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,689 |
2,220 |
$906K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,900 |
1,999 |
$492K |
| D9222 |
|
2,001 |
1,996 |
$253K |
| D7240 |
Removal of impacted tooth - completely bony |
785 |
317 |
$157K |
| D7230 |
|
644 |
404 |
$109K |
| D0330 |
Panoramic radiographic image |
1,946 |
1,940 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,177 |
2,167 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
942 |
929 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
220 |
220 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
51 |
$5K |
| D1120 |
Prophylaxis - child |
145 |
145 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
177 |
177 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
62 |
61 |
$3K |
| D1206 |
Topical application of fluoride varnish |
138 |
138 |
$2K |
| D1110 |
Prophylaxis - adult |
50 |
50 |
$2K |
| D0272 |
Bitewings - two radiographic images |
109 |
109 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
18 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
101 |
$792.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$486.72 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$448.00 |
| D1999 |
|
808 |
684 |
$0.00 |
| D1330 |
|
162 |
162 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D1310 |
|
43 |
43 |
$0.00 |