| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,401 |
1,913 |
$329K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,249 |
273 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,952 |
2,752 |
$58K |
| D7250 |
|
503 |
168 |
$27K |
| D7230 |
|
248 |
149 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
257 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$425.73 |
| D0230 |
Intraoral - periapical each additional radiographic image |
80 |
66 |
$197.76 |