| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
91 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
597 |
433 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
48 |
12 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
374 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
28 |
$791.35 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$587.04 |
| D1206 |
Topical application of fluoride varnish |
28 |
27 |
$497.75 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$390.36 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$256.34 |
| D0160 |
|
17 |
13 |
$140.85 |