| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
3,663 |
1,273 |
$952K |
| D9222 |
|
1,443 |
1,417 |
$77K |
| D7230 |
|
463 |
220 |
$75K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,642 |
1,416 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,728 |
$58K |
| D0330 |
Panoramic radiographic image |
876 |
854 |
$50K |
| D9610 |
|
1,290 |
1,266 |
$16K |
| D0367 |
|
26 |
25 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
114 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D9612 |
|
118 |
117 |
$895.75 |
| D9420 |
|
26 |
24 |
$871.44 |
| D0602 |
|
2,150 |
2,078 |
$0.00 |