| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,959 |
1,045 |
$53K |
| D0330 |
Panoramic radiographic image |
262 |
253 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
30 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$119.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
21 |
21 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
18 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$0.00 |
| D1999 |
|
142 |
141 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
21 |
21 |
$0.00 |
| D1120 |
Prophylaxis - child |
29 |
29 |
$0.00 |