| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
299 |
292 |
$105K |
| D7240 |
Removal of impacted tooth - completely bony |
308 |
92 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
841 |
290 |
$48K |
| D9222 |
|
299 |
292 |
$35K |
| D0330 |
Panoramic radiographic image |
227 |
226 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
279 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$2K |