| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,731 |
587 |
$171K |
| D7240 |
Removal of impacted tooth - completely bony |
941 |
332 |
$170K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
306 |
292 |
$56K |
| D7230 |
|
275 |
154 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,060 |
1,016 |
$42K |
| D7250 |
|
386 |
132 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
943 |
918 |
$37K |
| D9610 |
|
305 |
292 |
$10K |
| D0330 |
Panoramic radiographic image |
157 |
154 |
$8K |
| D7485 |
|
21 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
215 |
$3K |
| D7471 |
|
19 |
14 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
100 |
96 |
$2K |