| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,576 |
763 |
$487K |
| D7240 |
Removal of impacted tooth - completely bony |
1,569 |
520 |
$234K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,633 |
941 |
$94K |
| D9222 |
|
1,179 |
964 |
$52K |
| D7310 |
|
291 |
89 |
$50K |
| D9610 |
|
868 |
787 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,617 |
1,420 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
688 |
143 |
$30K |
| D0330 |
Panoramic radiographic image |
805 |
756 |
$29K |
| D7250 |
|
236 |
46 |
$26K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
189 |
176 |
$19K |
| D9243 |
|
137 |
90 |
$6K |
| D0340 |
|
144 |
135 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
64 |
64 |
$5K |
| D9239 |
|
103 |
96 |
$4K |
| D7220 |
|
21 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
35 |
$1K |
| D9310 |
|
230 |
146 |
$0.00 |