| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
663 |
223 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,766 |
410 |
$78K |
| D9310 |
|
609 |
583 |
$37K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
391 |
329 |
$31K |
| D9222 |
|
440 |
425 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
209 |
124 |
$16K |
| D0330 |
Panoramic radiographic image |
461 |
436 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
150 |
$5K |
| D7220 |
|
29 |
13 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$704.56 |
| D9612 |
|
69 |
69 |
$288.98 |