| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
637 |
294 |
$49K |
| D0367 |
|
1,030 |
984 |
$47K |
| D9310 |
|
1,712 |
1,667 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
922 |
904 |
$19K |
| D7240 |
Removal of impacted tooth - completely bony |
83 |
31 |
$19K |
| D1110 |
Prophylaxis - adult |
470 |
470 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
461 |
$12K |
| D0330 |
Panoramic radiographic image |
249 |
249 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
123 |
$5K |
| D0274 |
Bitewings - four radiographic images |
256 |
256 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
793 |
728 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
134 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
343 |
338 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$625.00 |
| D7953 |
|
15 |
12 |
$230.00 |