| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 40819 |
|
2,303 |
1,468 |
$336K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
2,482 |
1,673 |
$129K |
| 41115 |
|
1,989 |
1,234 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,005 |
331 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,524 |
1,457 |
$35K |
| D7240 |
Removal of impacted tooth - completely bony |
89 |
27 |
$20K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
257 |
191 |
$20K |
| 41520 |
|
95 |
54 |
$15K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
147 |
50 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
32 |
$13K |
| D0330 |
Panoramic radiographic image |
245 |
224 |
$5K |
| D9222 |
|
50 |
50 |
$5K |