| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,025 |
189 |
$61K |
| D7240 |
Removal of impacted tooth - completely bony |
463 |
131 |
$55K |
| D9222 |
|
338 |
296 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
313 |
$9K |
| D7230 |
|
79 |
33 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
242 |
176 |
$7K |
| D9610 |
|
286 |
249 |
$6K |
| D7310 |
|
80 |
29 |
$4K |
| D0330 |
Panoramic radiographic image |
394 |
349 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
32 |
$0.00 |
| D7311 |
|
44 |
18 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$0.00 |
| D7241 |
|
35 |
13 |
$0.00 |