| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7230 |
|
4,189 |
2,079 |
$788K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,463 |
3,369 |
$763K |
| D7240 |
Removal of impacted tooth - completely bony |
2,627 |
1,333 |
$604K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,724 |
8,688 |
$550K |
| D0330 |
Panoramic radiographic image |
7,069 |
7,036 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
365 |
359 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
41 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
268 |
$3K |
| D0364 |
|
2,706 |
2,696 |
$0.00 |