| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,896 |
815 |
$309K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,311 |
659 |
$256K |
| D7451 |
|
534 |
518 |
$123K |
| D7240 |
Removal of impacted tooth - completely bony |
477 |
168 |
$115K |
| D9222 |
|
659 |
656 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,532 |
1,497 |
$59K |
| D0330 |
Panoramic radiographic image |
1,955 |
1,930 |
$58K |
| D9430 |
|
1,921 |
1,436 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
710 |
661 |
$20K |
| D7241 |
|
26 |
13 |
$8K |
| D9420 |
|
31 |
28 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
74 |
72 |
$4K |
| D7450 |
|
25 |
25 |
$1K |
| D7412 |
|
13 |
13 |
$1K |