| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,928 |
530 |
$128K |
| D7240 |
Removal of impacted tooth - completely bony |
1,103 |
315 |
$105K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,175 |
1,081 |
$105K |
| D9310 |
|
1,869 |
1,550 |
$74K |
| D9222 |
|
1,361 |
1,064 |
$41K |
| D0330 |
Panoramic radiographic image |
1,009 |
833 |
$16K |
| D7230 |
|
157 |
53 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
287 |
39 |
$11K |
| D7310 |
|
33 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$184.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
19 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
30 |
$0.00 |