| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
5,077 |
1,699 |
$1.28M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,021 |
1,267 |
$581K |
| D9222 |
|
2,574 |
2,557 |
$275K |
| D7230 |
|
979 |
618 |
$220K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,553 |
1,224 |
$148K |
| D7220 |
|
402 |
283 |
$66K |
| D9310 |
|
1,514 |
1,498 |
$45K |
| D9610 |
|
1,706 |
1,691 |
$24K |
| D9612 |
|
1,509 |
1,495 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
49 |
$8K |
| D0330 |
Panoramic radiographic image |
138 |
138 |
$5K |
| D1120 |
Prophylaxis - child |
128 |
122 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
98 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
51 |
$1K |
| D1206 |
Topical application of fluoride varnish |
59 |
57 |
$773.82 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$716.52 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$270.27 |
| D1110 |
Prophylaxis - adult |
31 |
26 |
$214.92 |
| D7921 |
|
1,718 |
1,692 |
$58.90 |