| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
81 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
146 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
126 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
44 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
162 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
38 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
43 |
$306.28 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$282.84 |
| D5899 |
|
14 |
13 |
$246.00 |