| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,585 |
2,276 |
$178K |
| D0330 |
Panoramic radiographic image |
5,166 |
5,165 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,999 |
4,985 |
$99K |
| D7240 |
Removal of impacted tooth - completely bony |
152 |
142 |
$40K |
| D7230 |
|
203 |
202 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
837 |
819 |
$10K |
| D9243 |
|
39 |
39 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
38 |
$3K |
| D9239 |
|
25 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
57 |
$538.75 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$227.86 |
| D1999 |
|
547 |
517 |
$0.00 |