| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,188 |
350 |
$67K |
| D7240 |
Removal of impacted tooth - completely bony |
108 |
94 |
$55K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
147 |
142 |
$21K |
| D9222 |
|
175 |
169 |
$21K |
| D7230 |
|
67 |
61 |
$20K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
160 |
160 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
242 |
$4K |
| D0330 |
Panoramic radiographic image |
44 |
43 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$1K |