| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,805 |
1,222 |
$484K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,288 |
4,020 |
$450K |
| D9310 |
|
4,960 |
4,959 |
$303K |
| D9243 |
|
2,408 |
2,388 |
$270K |
| D0330 |
Panoramic radiographic image |
7,426 |
7,426 |
$228K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,723 |
1,380 |
$182K |
| D9239 |
|
2,328 |
2,318 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,973 |
2,973 |
$77K |
| D7230 |
|
389 |
326 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,214 |
2,212 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
205 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
425 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
278 |
278 |
$2K |
| D1999 |
|
56 |
56 |
$0.00 |