| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9222 |
|
651 |
576 |
$117K |
| D7240 |
Removal of impacted tooth - completely bony |
1,246 |
532 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
4,787 |
4,492 |
$62K |
| D0330 |
Panoramic radiographic image |
2,357 |
2,209 |
$49K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
820 |
512 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
622 |
262 |
$26K |
| D7230 |
|
188 |
103 |
$15K |
| D7241 |
|
71 |
38 |
$9K |
| D7220 |
|
18 |
12 |
$551.36 |
| D7250 |
|
28 |
12 |
$358.12 |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
83 |
$326.57 |
| D1999 |
|
303 |
291 |
$285.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
16 |
$104.38 |