| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32,485 |
5,320 |
$1.95M |
| D9243 |
|
21,184 |
6,127 |
$852K |
| D7240 |
Removal of impacted tooth - completely bony |
4,956 |
1,895 |
$818K |
| D7230 |
|
3,437 |
1,565 |
$525K |
| D9239 |
|
6,722 |
6,143 |
$471K |
| D0367 |
|
4,254 |
3,784 |
$346K |
| D7310 |
|
3,195 |
925 |
$323K |
| D0330 |
Panoramic radiographic image |
4,626 |
4,278 |
$190K |
| D9612 |
|
4,726 |
4,232 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,061 |
445 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
7,522 |
6,779 |
$165K |
| D9610 |
|
4,978 |
3,924 |
$108K |
| D7250 |
|
1,044 |
254 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
982 |
843 |
$30K |
| D7220 |
|
132 |
40 |
$13K |
| D0350 |
|
171 |
138 |
$2K |
| D1110 |
Prophylaxis - adult |
50 |
49 |
$2K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
46 |
15 |
$980.00 |
| D9222 |
|
19 |
15 |
$840.00 |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$666.12 |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$500.00 |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
75 |
$361.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
53 |
$255.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$180.00 |