| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,644 |
2,187 |
$187K |
| D7240 |
Removal of impacted tooth - completely bony |
440 |
332 |
$107K |
| D0330 |
Panoramic radiographic image |
2,734 |
2,733 |
$83K |
| D0160 |
|
3,538 |
3,538 |
$80K |
| D9222 |
|
350 |
347 |
$40K |
| D0367 |
|
116 |
116 |
$28K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
380 |
377 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
138 |
$10K |
| D7230 |
|
59 |
51 |
$8K |
| D9310 |
|
136 |
136 |
$7K |
| D7250 |
|
28 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
240 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
71 |
$968.20 |