| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,426 |
694 |
$118K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
710 |
691 |
$58K |
| D0160 |
|
1,104 |
1,070 |
$47K |
| D0330 |
Panoramic radiographic image |
1,217 |
1,196 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
758 |
651 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
123 |
51 |
$30K |
| D9222 |
|
665 |
653 |
$28K |
| D9430 |
|
991 |
839 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
499 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
391 |
382 |
$9K |
| D7451 |
|
36 |
28 |
$9K |
| D7250 |
|
73 |
25 |
$7K |
| D9310 |
|
340 |
337 |
$6K |
| D7911 |
|
36 |
34 |
$2K |
| D0180 |
|
22 |
22 |
$985.00 |