| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13,128 |
9,783 |
$936K |
| D9243 |
|
9,091 |
8,826 |
$630K |
| D9239 |
|
8,880 |
8,650 |
$468K |
| D0330 |
Panoramic radiographic image |
12,124 |
12,123 |
$349K |
| D9310 |
|
4,421 |
4,419 |
$188K |
| D0140 |
Limited oral evaluation - problem focused |
9,231 |
9,218 |
$99K |
| D7240 |
Removal of impacted tooth - completely bony |
224 |
188 |
$57K |
| D7230 |
|
370 |
321 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
744 |
476 |
$36K |
| D0367 |
|
271 |
270 |
$29K |
| D9430 |
|
702 |
659 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
42 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
94 |
$856.29 |
| D9222 |
|
30 |
28 |
$485.80 |
| D7953 |
|
26 |
24 |
$0.00 |
| D4266 |
|
13 |
12 |
$0.00 |