| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
2,827 |
1,823 |
$752K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,142 |
3,238 |
$489K |
| D9243 |
|
2,715 |
2,527 |
$329K |
| D7230 |
|
1,454 |
1,161 |
$261K |
| D0330 |
Panoramic radiographic image |
7,151 |
7,142 |
$242K |
| D9310 |
|
4,399 |
4,399 |
$236K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,488 |
892 |
$203K |
| D9239 |
|
2,276 |
2,270 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
3,974 |
3,964 |
$124K |
| D9222 |
|
895 |
891 |
$80K |
| D0364 |
|
287 |
280 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
531 |
343 |
$34K |
| D7220 |
|
122 |
92 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
1,067 |
$11K |
| D0367 |
|
12 |
12 |
$4K |
| D9995 |
|
49 |
49 |
$836.12 |
| D0365 |
|
15 |
12 |
$814.00 |
| D0160 |
|
16 |
16 |
$425.60 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$26.56 |
| D1999 |
|
169 |
148 |
$0.00 |