| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,549 |
1,425 |
$714K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,152 |
1,138 |
$332K |
| D9222 |
|
1,150 |
1,136 |
$136K |
| D7240 |
Removal of impacted tooth - completely bony |
398 |
165 |
$78K |
| D1110 |
Prophylaxis - adult |
975 |
974 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
576 |
243 |
$31K |
| D7230 |
|
179 |
101 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,320 |
$26K |
| D0330 |
Panoramic radiographic image |
607 |
606 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
450 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
945 |
944 |
$19K |
| D0274 |
Bitewings - four radiographic images |
576 |
576 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
137 |
$15K |
| D1120 |
Prophylaxis - child |
418 |
417 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
689 |
684 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
968 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
97 |
$7K |
| D1330 |
|
1,275 |
1,273 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
320 |
$6K |
| D0272 |
Bitewings - two radiographic images |
211 |
210 |
$3K |
| D1206 |
Topical application of fluoride varnish |
185 |
184 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
122 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
50 |
$3K |
| D7310 |
|
78 |
28 |
$2K |
| D2332 |
|
35 |
20 |
$2K |
| D0603 |
|
92 |
92 |
$910.00 |
| D1310 |
|
163 |
162 |
$854.12 |
| D7510 |
|
24 |
24 |
$637.50 |
| D0601 |
|
63 |
63 |
$630.00 |
| D0270 |
|
19 |
19 |
$152.00 |