| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25,459 |
8,441 |
$3.22M |
| D7230 |
|
2,789 |
1,522 |
$811K |
| D7240 |
Removal of impacted tooth - completely bony |
2,549 |
966 |
$795K |
| D0330 |
Panoramic radiographic image |
11,372 |
11,297 |
$591K |
| D9420 |
|
1,359 |
1,236 |
$412K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,860 |
7,824 |
$385K |
| D0140 |
Limited oral evaluation - problem focused |
6,645 |
6,478 |
$306K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,070 |
366 |
$107K |
| D7310 |
|
445 |
187 |
$73K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
75 |
75 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
206 |
205 |
$5K |
| D9222 |
|
71 |
71 |
$5K |
| D7510 |
|
39 |
39 |
$4K |
| D7311 |
|
29 |
26 |
$2K |
| D9612 |
|
77 |
77 |
$1K |
| D0171 |
|
27 |
26 |
$390.00 |