| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
2,540 |
766 |
$460K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,476 |
1,103 |
$365K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,774 |
1,608 |
$171K |
| D9222 |
|
1,980 |
1,795 |
$140K |
| D0330 |
Panoramic radiographic image |
1,066 |
1,000 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,316 |
1,246 |
$41K |
| D9310 |
|
942 |
871 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
507 |
142 |
$28K |
| D9630 |
|
598 |
511 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
82 |
$3K |
| D9612 |
|
31 |
29 |
$455.00 |
| D1999 |
|
113 |
91 |
$42.50 |