| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
262 |
108 |
$41K |
| D7240 |
Removal of impacted tooth - completely bony |
142 |
42 |
$40K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
100 |
88 |
$19K |
| D0330 |
Panoramic radiographic image |
329 |
295 |
$17K |
| D9222 |
|
101 |
89 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
204 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
16 |
$7K |
| D7230 |
|
23 |
12 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
66 |
$3K |