| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,478 |
1,276 |
$100K |
| D0160 |
|
1,339 |
1,329 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,741 |
1,683 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,543 |
1,502 |
$15K |
| D9222 |
|
215 |
205 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
478 |
468 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
76 |
$5K |
| D9243 |
|
64 |
62 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
69 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$900.00 |
| D9310 |
|
16 |
16 |
$408.15 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$166.49 |