| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,621 |
734 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
2,703 |
1,898 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
603 |
461 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
492 |
106 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
600 |
142 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,029 |
1,425 |
$18K |
| D0330 |
Panoramic radiographic image |
728 |
379 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,551 |
867 |
$10K |
| D0274 |
Bitewings - four radiographic images |
476 |
357 |
$8K |
| D9248 |
|
143 |
106 |
$7K |
| D7230 |
|
295 |
59 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
600 |
285 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
134 |
$4K |
| D1120 |
Prophylaxis - child |
78 |
62 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
27 |
25 |
$841.60 |
| D7220 |
|
36 |
12 |
$600.00 |
| D0120 |
Periodic oral evaluation - established patient |
23 |
12 |
$240.00 |
| D1999 |
|
256 |
202 |
$0.00 |