| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,081 |
145 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
398 |
$18K |
| D0330 |
Panoramic radiographic image |
418 |
402 |
$15K |
| D5110 |
|
32 |
28 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
25 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
110 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101 |
51 |
$1K |
| D0274 |
Bitewings - four radiographic images |
14 |
12 |
$388.19 |