| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,006 |
1,244 |
$332K |
| D7230 |
|
379 |
215 |
$86K |
| D7240 |
Removal of impacted tooth - completely bony |
229 |
114 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
854 |
833 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
536 |
$30K |
| D0330 |
Panoramic radiographic image |
565 |
554 |
$25K |
| 70355 |
|
394 |
361 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
41 |
38 |
$4K |
| 99215 |
Prolong outpt/office vis |
37 |
33 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$1K |