| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,365 |
2,371 |
$886K |
| D7240 |
Removal of impacted tooth - completely bony |
4,487 |
1,536 |
$846K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,324 |
3,032 |
$485K |
| D9222 |
|
2,765 |
2,621 |
$208K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,534 |
886 |
$195K |
| D7230 |
|
1,010 |
615 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,211 |
3,042 |
$151K |
| D0330 |
Panoramic radiographic image |
3,541 |
3,345 |
$128K |
| D7310 |
|
261 |
88 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
898 |
845 |
$25K |
| D7220 |
|
152 |
102 |
$17K |
| D7250 |
|
109 |
38 |
$11K |
| D9610 |
|
13 |
13 |
$325.00 |