| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9310 |
|
937 |
936 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
370 |
348 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
517 |
503 |
$49K |
| D0330 |
Panoramic radiographic image |
857 |
856 |
$23K |
| D1110 |
Prophylaxis - adult |
301 |
301 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
1,000 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
423 |
423 |
$5K |
| D0274 |
Bitewings - four radiographic images |
155 |
155 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
158 |
158 |
$4K |
| D0270 |
|
209 |
209 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
68 |
$879.00 |
| D1999 |
|
101 |
96 |
$0.00 |