| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,722 |
788 |
$263K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
355 |
316 |
$108K |
| D9222 |
|
324 |
316 |
$42K |
| D0330 |
Panoramic radiographic image |
510 |
506 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
833 |
821 |
$16K |
| D1110 |
Prophylaxis - adult |
477 |
471 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
324 |
317 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
231 |
142 |
$14K |
| D1206 |
Topical application of fluoride varnish |
518 |
514 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
374 |
368 |
$7K |
| D1310 |
|
719 |
694 |
$6K |
| D1330 |
|
707 |
684 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
362 |
$6K |
| D1120 |
Prophylaxis - child |
182 |
182 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
578 |
568 |
$5K |
| D7230 |
|
18 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
30 |
$2K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$975.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$682.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$432.00 |