| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,427 |
961 |
$303K |
| D0140 |
Limited oral evaluation - problem focused |
1,811 |
1,535 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
775 |
702 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$300.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
16 |
$242.36 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
12 |
$86.64 |