| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
13,384 |
3,713 |
$3.24M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,652 |
4,744 |
$468K |
| D9222 |
|
5,265 |
4,773 |
$445K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,229 |
880 |
$256K |
| D0140 |
Limited oral evaluation - problem focused |
7,801 |
7,377 |
$248K |
| D0330 |
Panoramic radiographic image |
2,376 |
2,275 |
$88K |
| D7230 |
|
130 |
68 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
403 |
116 |
$25K |
| D9610 |
|
108 |
87 |
$378.51 |
| D0272 |
Bitewings - two radiographic images |
715 |
712 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
733 |
730 |
$0.00 |
| D1351 |
Sealant - per tooth |
84 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
744 |
741 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
180 |
112 |
$0.00 |
| D1110 |
Prophylaxis - adult |
375 |
373 |
$0.00 |
| D2140 |
|
67 |
52 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
115 |
$0.00 |
| D1120 |
Prophylaxis - child |
289 |
288 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
26 |
$0.00 |