| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,138 |
497 |
$189K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
852 |
472 |
$133K |
| D9222 |
|
483 |
473 |
$68K |
| D7240 |
Removal of impacted tooth - completely bony |
320 |
117 |
$63K |
| D0330 |
Panoramic radiographic image |
631 |
624 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
790 |
782 |
$16K |
| D7230 |
|
69 |
44 |
$12K |
| D1110 |
Prophylaxis - adult |
20 |
20 |
$684.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$336.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$240.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$240.00 |
| D1999 |
|
325 |
274 |
$0.00 |