| Code | Description | Claims | Beneficiaries | Total Paid |
| D7240 |
Removal of impacted tooth - completely bony |
1,543 |
952 |
$365K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,176 |
3,278 |
$364K |
| D9310 |
|
4,376 |
4,376 |
$230K |
| D0330 |
Panoramic radiographic image |
4,856 |
4,853 |
$139K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,094 |
1,090 |
$101K |
| D9222 |
|
1,094 |
1,091 |
$60K |
| D7230 |
|
271 |
206 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,585 |
1,585 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
228 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
174 |
172 |
$5K |
| D9610 |
|
353 |
353 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$117.29 |