| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9243 |
|
69 |
64 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
48 |
$7K |
| D0330 |
Panoramic radiographic image |
283 |
269 |
$3K |
| D0160 |
|
33 |
33 |
$763.05 |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
500 |
$543.17 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$35.00 |
| D0120 |
Periodic oral evaluation - established patient |
957 |
957 |
$27.55 |
| D0240 |
|
32 |
32 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
506 |
506 |
$0.00 |
| D1110 |
Prophylaxis - adult |
561 |
560 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |