| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,150 |
1,180 |
$310K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,888 |
536 |
$212K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,601 |
1,526 |
$160K |
| D7240 |
Removal of impacted tooth - completely bony |
553 |
198 |
$149K |
| D9222 |
|
1,269 |
1,215 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,802 |
1,762 |
$86K |
| D0330 |
Panoramic radiographic image |
1,138 |
1,100 |
$44K |
| D7230 |
|
83 |
53 |
$20K |
| 99242 |
|
14 |
14 |
$610.47 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
14 |
$278.85 |
| 99201 |
|
14 |
12 |
$177.96 |