| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,797 |
1,574 |
$206K |
| D0330 |
Panoramic radiographic image |
3,818 |
3,785 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,935 |
2,906 |
$67K |
| D9243 |
|
183 |
168 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
96 |
56 |
$25K |
| D9310 |
|
647 |
647 |
$19K |
| D9239 |
|
90 |
80 |
$6K |
| D0367 |
|
25 |
25 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
346 |
334 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$446.00 |
| D0160 |
|
12 |
12 |
$255.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$78.95 |
| D4265 |
|
157 |
78 |
$0.00 |
| D1999 |
|
220 |
211 |
$0.00 |