| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
304 |
300 |
$85K |
| D9222 |
|
316 |
312 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,032 |
304 |
$58K |
| D9243 |
|
104 |
104 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
185 |
67 |
$34K |
| D9239 |
|
104 |
104 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
183 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
157 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
120 |
120 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$2K |
| D0160 |
|
87 |
87 |
$2K |