| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,048 |
1,099 |
$268K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,033 |
736 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,999 |
831 |
$170K |
| D9222 |
|
1,131 |
1,070 |
$142K |
| D0330 |
Panoramic radiographic image |
2,848 |
2,757 |
$119K |
| D7240 |
Removal of impacted tooth - completely bony |
489 |
171 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,955 |
2,863 |
$70K |
| D8670 |
Periodic orthodontic treatment visit |
59 |
59 |
$21K |
| D1110 |
Prophylaxis - adult |
229 |
228 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
211 |
211 |
$4K |
| D1206 |
Topical application of fluoride varnish |
72 |
71 |
$1K |
| D0274 |
Bitewings - four radiographic images |
40 |
39 |
$1K |
| D1330 |
|
90 |
90 |
$450.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$176.00 |
| D0601 |
|
13 |
13 |
$130.00 |