| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,453 |
1,396 |
$157K |
| D9222 |
|
1,345 |
1,343 |
$134K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,335 |
1,329 |
$81K |
| D0330 |
Panoramic radiographic image |
2,209 |
2,209 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,465 |
1,465 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
135 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
99 |
52 |
$20K |
| D9310 |
|
359 |
359 |
$14K |
| D7230 |
|
17 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
288 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$438.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$71.00 |