| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
626 |
201 |
$102K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
563 |
545 |
$91K |
| T2035 |
Utility services to support medical equipment and assistive technology/devices, waiver |
229 |
227 |
$71K |
| D9222 |
|
546 |
544 |
$42K |
| D0330 |
Panoramic radiographic image |
782 |
778 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
851 |
842 |
$21K |
| D9630 |
|
570 |
561 |
$11K |
| D9612 |
|
235 |
235 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
14 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$484.00 |