| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
823 |
812 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
692 |
638 |
$39K |
| D9243 |
|
390 |
386 |
$26K |
| D0330 |
Panoramic radiographic image |
990 |
987 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
886 |
$17K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
312 |
311 |
$16K |
| D9222 |
|
271 |
270 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
375 |
$3K |
| D9239 |
|
76 |
74 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
224 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$110.80 |