| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,931 |
1,927 |
$570K |
| D7240 |
Removal of impacted tooth - completely bony |
1,304 |
503 |
$242K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,856 |
1,770 |
$212K |
| D9310 |
|
2,664 |
2,618 |
$191K |
| D7250 |
|
1,354 |
422 |
$167K |
| D7230 |
|
814 |
466 |
$149K |
| D0330 |
Panoramic radiographic image |
2,300 |
2,264 |
$102K |
| D9222 |
|
1,798 |
1,771 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$620.75 |