| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,547 |
1,543 |
$102K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
776 |
313 |
$92K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
283 |
172 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,310 |
1,308 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
112 |
99 |
$53K |
| D0340 |
|
954 |
950 |
$47K |
| D0330 |
Panoramic radiographic image |
1,338 |
1,333 |
$39K |
| D0350 |
|
3,452 |
935 |
$32K |
| D9430 |
|
994 |
953 |
$32K |
| D9222 |
|
175 |
173 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
28 |
$13K |
| D9610 |
|
244 |
153 |
$12K |
| D1110 |
Prophylaxis - adult |
134 |
131 |
$10K |
| D2954 |
|
90 |
79 |
$9K |
| D1206 |
Topical application of fluoride varnish |
243 |
242 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
133 |
$599.40 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$420.00 |
| D0274 |
Bitewings - four radiographic images |
21 |
21 |
$345.60 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$180.00 |