| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,206 |
1,395 |
$501K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,075 |
1,068 |
$256K |
| D9310 |
|
1,170 |
1,170 |
$126K |
| D9222 |
|
936 |
928 |
$79K |
| D0330 |
Panoramic radiographic image |
1,669 |
1,665 |
$72K |
| D7240 |
Removal of impacted tooth - completely bony |
76 |
41 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
90 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
562 |
560 |
$20K |
| D7450 |
|
40 |
40 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$387.50 |