| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,745 |
324 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
910 |
120 |
$88K |
| D5110 |
|
85 |
75 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,457 |
1,381 |
$35K |
| D5120 |
|
25 |
25 |
$30K |
| D0330 |
Panoramic radiographic image |
406 |
394 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
655 |
243 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
131 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
405 |
$5K |
| D1330 |
|
82 |
80 |
$3K |
| D5850 |
|
14 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$600.41 |