| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
462 |
168 |
$130K |
| D0330 |
Panoramic radiographic image |
1,112 |
1,111 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
827 |
827 |
$34K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
303 |
262 |
$28K |
| D9222 |
|
264 |
262 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
51 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
111 |
111 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
144 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
159 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$578.76 |