| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,337 |
1,106 |
$197K |
| D0140 |
Limited oral evaluation - problem focused |
1,058 |
1,050 |
$39K |
| D0330 |
Panoramic radiographic image |
628 |
628 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
216 |
171 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
471 |
471 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,251 |
1,230 |
$16K |
| D1110 |
Prophylaxis - adult |
266 |
266 |
$13K |
| D0272 |
Bitewings - two radiographic images |
580 |
580 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
77 |
77 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$124.68 |