| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,414 |
453 |
$342K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,566 |
773 |
$325K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,089 |
1,063 |
$113K |
| D9222 |
|
1,158 |
1,130 |
$99K |
| D9310 |
|
1,049 |
1,018 |
$58K |
| D0330 |
Panoramic radiographic image |
662 |
644 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
316 |
$12K |
| D9630 |
|
537 |
524 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
13 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$455.78 |