| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,396 |
2,024 |
$546K |
| D7240 |
Removal of impacted tooth - completely bony |
2,396 |
828 |
$441K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,343 |
2,249 |
$353K |
| D9222 |
|
2,334 |
2,239 |
$153K |
| D7250 |
|
1,094 |
340 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,350 |
2,293 |
$97K |
| D7230 |
|
502 |
291 |
$77K |
| D0330 |
Panoramic radiographic image |
1,023 |
984 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,082 |
1,040 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
565 |
198 |
$32K |
| D9610 |
|
677 |
663 |
$23K |
| D7310 |
|
173 |
82 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$557.22 |