| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18,007 |
7,449 |
$2.11M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,238 |
11,202 |
$708K |
| D7230 |
|
2,903 |
1,466 |
$543K |
| D0330 |
Panoramic radiographic image |
11,218 |
11,176 |
$328K |
| D7240 |
Removal of impacted tooth - completely bony |
1,385 |
670 |
$314K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,348 |
859 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
694 |
688 |
$36K |
| D7220 |
|
88 |
58 |
$12K |
| D0274 |
Bitewings - four radiographic images |
622 |
613 |
$12K |
| D9430 |
|
150 |
150 |
$5K |
| D0272 |
Bitewings - two radiographic images |
231 |
229 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
78 |
$936.00 |
| D9110 |
|
28 |
28 |
$189.00 |