| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,881 |
1,108 |
$438K |
| D7240 |
Removal of impacted tooth - completely bony |
1,378 |
491 |
$315K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,317 |
2,334 |
$267K |
| D9222 |
|
3,061 |
2,942 |
$235K |
| D7230 |
|
903 |
363 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,478 |
5,353 |
$153K |
| D9612 |
|
2,656 |
2,574 |
$121K |
| 99205 |
Prolong outpt/office vis |
1,034 |
916 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,241 |
366 |
$77K |
| D0330 |
Panoramic radiographic image |
2,623 |
2,562 |
$43K |
| 70486 |
|
293 |
258 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,578 |
1,449 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,986 |
1,915 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,831 |
1,796 |
$12K |
| 70355 |
|
171 |
153 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
26 |
$1K |
| 99215 |
Prolong outpt/office vis |
19 |
13 |
$980.72 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$501.69 |
| D0274 |
Bitewings - four radiographic images |
83 |
83 |
$84.84 |
| D0270 |
|
508 |
504 |
$46.92 |
| D0273 |
|
37 |
37 |
$0.00 |
| D1999 |
|
294 |
293 |
$0.00 |