| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,515 |
4,248 |
$1.20M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
11,238 |
3,535 |
$745K |
| D9222 |
|
4,247 |
4,049 |
$495K |
| D7240 |
Removal of impacted tooth - completely bony |
1,342 |
707 |
$253K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,967 |
723 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,222 |
5,196 |
$124K |
| D0330 |
Panoramic radiographic image |
3,621 |
3,595 |
$119K |
| D7230 |
|
375 |
294 |
$59K |
| D7261 |
|
338 |
330 |
$37K |
| D9612 |
|
1,176 |
1,115 |
$35K |
| D1320 |
|
1,735 |
1,721 |
$29K |
| D7485 |
|
215 |
206 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
88 |
87 |
$21K |
| D7961 |
|
130 |
120 |
$17K |
| D7310 |
|
542 |
255 |
$16K |
| D7473 |
|
89 |
86 |
$11K |
| D0367 |
|
292 |
289 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
126 |
$4K |
| D0191 |
|
106 |
106 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
59 |
$1K |
| D1999 |
|
309 |
297 |
$25.00 |
| D9630 |
|
607 |
550 |
$0.00 |
| D9610 |
|
176 |
155 |
$0.00 |