| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,383 |
4,082 |
$512K |
| D9222 |
|
3,813 |
3,758 |
$245K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,806 |
3,749 |
$245K |
| D0330 |
Panoramic radiographic image |
6,491 |
6,489 |
$212K |
| D7230 |
|
818 |
677 |
$123K |
| D9310 |
|
2,104 |
2,103 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,894 |
1,208 |
$91K |
| D7240 |
Removal of impacted tooth - completely bony |
188 |
164 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
4,451 |
4,448 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
948 |
942 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
408 |
$4K |
| D9243 |
|
37 |
37 |
$3K |
| D0160 |
|
54 |
54 |
$1K |
| D9239 |
|
13 |
13 |
$728.90 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$130.14 |