| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
409 |
142 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
475 |
172 |
$54K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
541 |
386 |
$42K |
| D9222 |
|
386 |
386 |
$22K |
| D9610 |
|
413 |
413 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
217 |
$8K |
| D9239 |
|
26 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
71 |
$2K |
| D9243 |
|
28 |
26 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27 |
27 |
$2K |