| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,160 |
381 |
$267K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,508 |
1,042 |
$239K |
| D9222 |
|
1,112 |
998 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,962 |
1,864 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
328 |
125 |
$33K |
| D0330 |
Panoramic radiographic image |
1,850 |
1,756 |
$25K |
| D7230 |
|
77 |
40 |
$15K |
| D1110 |
Prophylaxis - adult |
227 |
184 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
213 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
269 |
226 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
126 |
$4K |
| D1120 |
Prophylaxis - child |
146 |
136 |
$4K |
| D1206 |
Topical application of fluoride varnish |
306 |
275 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
12 |
$2K |
| D2140 |
|
45 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
15 |
14 |
$371.28 |