| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,524 |
1,071 |
$352K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,748 |
695 |
$331K |
| D7240 |
Removal of impacted tooth - completely bony |
961 |
344 |
$302K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,018 |
502 |
$192K |
| D9222 |
|
1,077 |
1,065 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,346 |
1,341 |
$118K |
| D0330 |
Panoramic radiographic image |
1,166 |
1,158 |
$87K |
| D7450 |
|
192 |
129 |
$45K |
| D7230 |
|
144 |
86 |
$39K |
| D7310 |
|
234 |
97 |
$29K |
| D7250 |
|
50 |
16 |
$10K |
| D7961 |
|
13 |
12 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$2K |
| D1999 |
|
13 |
13 |
$0.00 |