| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
113 |
62 |
$14K |
| D0274 |
Bitewings - four radiographic images |
402 |
402 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
344 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
454 |
454 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
217 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$831.64 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$182.00 |