| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
8,854 |
3,562 |
$2.02M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,520 |
3,397 |
$1.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
13,497 |
4,570 |
$754K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,529 |
11,466 |
$722K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,064 |
2,433 |
$575K |
| D9220 |
|
1,962 |
1,951 |
$411K |
| D9222 |
|
2,931 |
2,929 |
$351K |
| D0330 |
Panoramic radiographic image |
12,748 |
12,658 |
$346K |
| D7230 |
|
1,380 |
697 |
$259K |
| D9221 |
|
1,754 |
1,310 |
$116K |
| D7283 |
|
102 |
75 |
$19K |
| D9430 |
|
577 |
563 |
$17K |
| D7280 |
|
104 |
77 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,457 |
1,520 |
$9K |
| D1120 |
Prophylaxis - child |
122 |
122 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
174 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
40 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
29 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
179 |
$2K |
| D9410 |
|
58 |
58 |
$2K |
| D1206 |
Topical application of fluoride varnish |
138 |
138 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$560.00 |
| D0272 |
Bitewings - two radiographic images |
54 |
53 |
$460.00 |
| D0270 |
|
71 |
67 |
$330.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$162.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$98.00 |