| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,281 |
2,068 |
$246K |
| D0330 |
Panoramic radiographic image |
3,549 |
3,524 |
$106K |
| D9243 |
|
920 |
911 |
$74K |
| D9239 |
|
850 |
841 |
$61K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
475 |
468 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
2,995 |
2,978 |
$45K |
| D9310 |
|
612 |
612 |
$30K |
| D9222 |
|
238 |
234 |
$19K |
| D7230 |
|
60 |
52 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
66 |
$7K |
| D0160 |
|
218 |
218 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
21 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
572 |
$5K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
45 |
45 |
$832.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$126.00 |
| D1999 |
|
27 |
27 |
$0.00 |