| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,757 |
2,838 |
$129K |
| D7240 |
Removal of impacted tooth - completely bony |
1,234 |
665 |
$113K |
| D7230 |
|
1,273 |
835 |
$93K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,990 |
1,128 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,491 |
4,444 |
$61K |
| D0330 |
Panoramic radiographic image |
4,553 |
4,504 |
$55K |
| D9222 |
|
1,171 |
1,145 |
$27K |
| D9310 |
|
503 |
486 |
$8K |
| D0160 |
|
396 |
388 |
$7K |
| D0367 |
|
288 |
282 |
$5K |
| D0170 |
|
786 |
758 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
75 |
$2K |
| D7220 |
|
22 |
14 |
$1K |
| D9610 |
|
371 |
357 |
$883.00 |
| D9630 |
|
357 |
340 |
$587.00 |
| D9613 |
|
190 |
127 |
$540.00 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$537.10 |
| D0171 |
|
28 |
27 |
$395.00 |