| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,096 |
694 |
$182K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
503 |
480 |
$122K |
| D9222 |
|
324 |
319 |
$38K |
| D0330 |
Panoramic radiographic image |
886 |
880 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
972 |
961 |
$12K |
| D1110 |
Prophylaxis - adult |
212 |
212 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
222 |
219 |
$4K |
| D1120 |
Prophylaxis - child |
115 |
112 |
$3K |
| D1206 |
Topical application of fluoride varnish |
127 |
124 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$734.85 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$528.00 |
| D0272 |
Bitewings - two radiographic images |
19 |
19 |
$278.20 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$207.55 |
| D1310 |
|
56 |
54 |
$144.35 |
| D1330 |
|
57 |
55 |
$66.48 |