| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
983 |
332 |
$200K |
| D9310 |
|
1,464 |
1,443 |
$106K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,591 |
742 |
$88K |
| D9222 |
|
768 |
747 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
92 |
$20K |
| D0330 |
Panoramic radiographic image |
267 |
260 |
$14K |
| D9612 |
|
437 |
427 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
14 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$404.88 |