| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,047 |
550 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,022 |
141 |
$108K |
| D9222 |
|
608 |
605 |
$94K |
| D7240 |
Removal of impacted tooth - completely bony |
265 |
104 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
647 |
171 |
$53K |
| D7310 |
|
178 |
53 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,361 |
1,297 |
$33K |
| D7250 |
|
182 |
43 |
$24K |
| D7230 |
|
101 |
45 |
$20K |
| D9610 |
|
252 |
241 |
$18K |
| D9612 |
|
341 |
337 |
$18K |
| D0330 |
Panoramic radiographic image |
238 |
236 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
344 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
89 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
47 |
$4K |
| D9243 |
|
54 |
23 |
$4K |
| D9239 |
|
46 |
46 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
33 |
$3K |
| D1110 |
Prophylaxis - adult |
97 |
96 |
$3K |
| D0250 |
|
218 |
217 |
$3K |
| D0274 |
Bitewings - four radiographic images |
88 |
87 |
$1K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$825.00 |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$683.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
35 |
$545.00 |
| D0220 |
Intraoral - periapical first radiographic image |
116 |
112 |
$530.25 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$500.00 |