| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,211 |
2,558 |
$654K |
| D7240 |
Removal of impacted tooth - completely bony |
2,609 |
1,020 |
$633K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,890 |
1,577 |
$320K |
| D9310 |
|
2,230 |
2,192 |
$173K |
| D7230 |
|
799 |
514 |
$160K |
| D7250 |
|
880 |
373 |
$156K |
| D9222 |
|
1,561 |
1,523 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
3,061 |
3,020 |
$88K |
| D0330 |
Panoramic radiographic image |
1,249 |
1,227 |
$69K |
| D7220 |
|
16 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
141 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$703.34 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
24 |
$259.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
14 |
$158.40 |