| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,357 |
1,338 |
$363K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,083 |
1,038 |
$284K |
| D0160 |
|
2,120 |
2,087 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,341 |
321 |
$127K |
| D9222 |
|
1,062 |
1,018 |
$113K |
| D0330 |
Panoramic radiographic image |
2,165 |
2,135 |
$112K |
| D7230 |
|
369 |
183 |
$83K |
| D7240 |
Removal of impacted tooth - completely bony |
87 |
40 |
$25K |
| D9219 |
|
556 |
533 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
288 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
126 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$978.50 |
| D9310 |
|
14 |
14 |
$553.14 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$536.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$205.22 |