| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,768 |
4,071 |
$1.99M |
| D7240 |
Removal of impacted tooth - completely bony |
1,884 |
1,061 |
$1.12M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,574 |
1,566 |
$489K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,119 |
515 |
$290K |
| D9222 |
|
1,569 |
1,568 |
$193K |
| D9310 |
|
1,841 |
1,841 |
$158K |
| D9243 |
|
418 |
418 |
$153K |
| D7230 |
|
426 |
307 |
$135K |
| D7250 |
|
316 |
164 |
$89K |
| D0330 |
Panoramic radiographic image |
1,543 |
1,543 |
$73K |
| D9239 |
|
404 |
404 |
$63K |
| D7220 |
|
141 |
86 |
$40K |
| D0367 |
|
118 |
118 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
475 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
464 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$227.28 |