| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
198 |
190 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
822 |
289 |
$43K |
| D9222 |
|
191 |
190 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
80 |
26 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
312 |
308 |
$7K |
| D0330 |
Panoramic radiographic image |
112 |
110 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
32 |
$713.00 |