| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,217 |
176 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
211 |
84 |
$48K |
| D5130 |
|
30 |
30 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
291 |
$18K |
| D0330 |
Panoramic radiographic image |
186 |
186 |
$16K |
| D7311 |
|
58 |
28 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
108 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
366 |
159 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
186 |
186 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$508.00 |