| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
337 |
332 |
$66K |
| D9222 |
|
347 |
342 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
490 |
191 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
498 |
149 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
81 |
32 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
341 |
$10K |
| D0330 |
Panoramic radiographic image |
230 |
227 |
$10K |
| D7230 |
|
38 |
25 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$840.00 |
| D9610 |
|
52 |
52 |
$0.00 |