| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,423 |
459 |
$193K |
| D7240 |
Removal of impacted tooth - completely bony |
617 |
177 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
976 |
931 |
$39K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
942 |
361 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,323 |
1,195 |
$14K |
| D9222 |
|
351 |
347 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,263 |
1,212 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
236 |
$7K |