| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
242 |
205 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,125 |
222 |
$61K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
381 |
373 |
$49K |
| D9222 |
|
382 |
373 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
296 |
290 |
$14K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
241 |
237 |
$8K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$742.22 |