| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,486 |
546 |
$340K |
| D7230 |
|
962 |
395 |
$152K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,895 |
1,219 |
$90K |
| D9310 |
|
1,283 |
1,269 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
593 |
356 |
$70K |
| D9222 |
|
1,309 |
1,284 |
$68K |
| D0330 |
Panoramic radiographic image |
1,051 |
1,047 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
729 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
106 |
$17K |
| D9239 |
|
26 |
26 |
$1K |
| D9612 |
|
306 |
296 |
$1K |
| D9243 |
|
16 |
12 |
$840.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
24 |
$809.76 |