| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,628 |
1,618 |
$287K |
| D9243 |
|
1,271 |
1,264 |
$132K |
| D9239 |
|
804 |
800 |
$46K |
| D7240 |
Removal of impacted tooth - completely bony |
161 |
71 |
$41K |
| D0330 |
Panoramic radiographic image |
1,261 |
1,260 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,045 |
1,044 |
$26K |
| D9310 |
|
313 |
313 |
$16K |
| D8670 |
Periodic orthodontic treatment visit |
48 |
48 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
27 |
$4K |
| D7230 |
|
26 |
14 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
27 |
27 |
$4K |
| D9222 |
|
45 |
43 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
454 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
150 |
$2K |
| D1110 |
Prophylaxis - adult |
278 |
277 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
265 |
262 |
$544.35 |
| D0120 |
Periodic oral evaluation - established patient |
268 |
267 |
$483.15 |
| D0274 |
Bitewings - four radiographic images |
103 |
103 |
$14.00 |