| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
74 |
28 |
$20K |
| D7230 |
|
73 |
26 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
26 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
109 |
103 |
$4K |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
26 |
26 |
$663.90 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$165.00 |
| D9613 |
|
80 |
76 |
$0.00 |