| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,209 |
3,234 |
$681K |
| D0330 |
Panoramic radiographic image |
4,757 |
4,412 |
$237K |
| D9310 |
|
7,730 |
7,098 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
1,843 |
1,721 |
$47K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
193 |
176 |
$37K |
| D7230 |
|
117 |
45 |
$28K |
| D9222 |
|
190 |
171 |
$18K |
| D7240 |
Removal of impacted tooth - completely bony |
79 |
14 |
$12K |
| D0412 |
|
16 |
13 |
$38.50 |
| D0272 |
Bitewings - two radiographic images |
32 |
27 |
$0.00 |
| D1351 |
Sealant - per tooth |
24 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
102 |
92 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
116 |
104 |
$0.00 |
| D1120 |
Prophylaxis - child |
118 |
106 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
21 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
23 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
17 |
$0.00 |