| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,530 |
2,221 |
$506K |
| D0140 |
Limited oral evaluation - problem focused |
2,716 |
2,584 |
$47K |
| D0330 |
Panoramic radiographic image |
768 |
718 |
$20K |
| D7230 |
|
92 |
76 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
21 |
20 |
$560.00 |
| D0274 |
Bitewings - four radiographic images |
21 |
20 |
$321.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$87.40 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$78.40 |
| D1999 |
|
145 |
124 |
$0.00 |