| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
4,738 |
1,843 |
$1.14M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,083 |
3,999 |
$742K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,329 |
1,328 |
$239K |
| D0330 |
Panoramic radiographic image |
5,523 |
5,521 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,704 |
4,701 |
$111K |
| D9222 |
|
1,313 |
1,313 |
$81K |
| D9310 |
|
1,074 |
1,074 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
507 |
505 |
$21K |
| D0367 |
|
29 |
29 |
$10K |
| D7230 |
|
44 |
27 |
$9K |
| D0160 |
|
283 |
283 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
70 |
$3K |
| D1999 |
|
77 |
73 |
$0.00 |