| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
356 |
354 |
$75K |
| D7240 |
Removal of impacted tooth - completely bony |
218 |
75 |
$50K |
| D9222 |
|
365 |
363 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
623 |
190 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
315 |
138 |
$28K |
| D0330 |
Panoramic radiographic image |
252 |
252 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
366 |
366 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$870.00 |
| D9610 |
|
33 |
33 |
$0.00 |