| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
874 |
433 |
$83K |
| D0330 |
Panoramic radiographic image |
519 |
509 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
706 |
692 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
457 |
$13K |
| D9992 |
|
1,327 |
1,230 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
148 |
148 |
$2K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$871.52 |