| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
324 |
53 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
242 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
57 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
87 |
$4K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
88 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$618.60 |
| D0274 |
Bitewings - four radiographic images |
18 |
17 |
$400.69 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
19 |
$111.91 |