| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,213 |
334 |
$117K |
| D7240 |
Removal of impacted tooth - completely bony |
471 |
136 |
$80K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,244 |
599 |
$79K |
| D9222 |
|
669 |
613 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
698 |
629 |
$26K |
| D7241 |
|
61 |
13 |
$9K |
| D0160 |
|
89 |
88 |
$6K |
| D9243 |
|
44 |
30 |
$4K |
| D9239 |
|
43 |
31 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
93 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80 |
39 |
$874.54 |
| D9610 |
|
22 |
22 |
$733.92 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$404.28 |
| D1999 |
|
18 |
12 |
$0.00 |