| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
426 |
415 |
$24K |
| D0160 |
|
363 |
358 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
480 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
379 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
122 |
$2K |
| D9310 |
|
72 |
72 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
13 |
$546.50 |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
28 |
$387.50 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$152.10 |