| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,960 |
1,569 |
$283K |
| D9243 |
|
2,192 |
1,055 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,596 |
656 |
$128K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,458 |
847 |
$108K |
| D9239 |
|
1,107 |
1,058 |
$82K |
| D9222 |
|
873 |
844 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,173 |
2,112 |
$52K |
| D7250 |
|
417 |
192 |
$39K |
| D0330 |
Panoramic radiographic image |
452 |
444 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,578 |
824 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,051 |
1,011 |
$11K |
| D9610 |
|
458 |
439 |
$6K |
| D7230 |
|
21 |
12 |
$4K |