| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
3,765 |
1,557 |
$1.14M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,835 |
2,609 |
$408K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,926 |
3,915 |
$277K |
| D9222 |
|
3,925 |
3,915 |
$277K |
| D0330 |
Panoramic radiographic image |
4,873 |
4,872 |
$180K |
| D7230 |
|
664 |
419 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,392 |
4,392 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
1,527 |
1,525 |
$74K |
| D7250 |
|
859 |
440 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
618 |
262 |
$29K |
| D0364 |
|
158 |
91 |
$435.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$65.00 |
| D1999 |
|
13 |
12 |
$0.00 |