| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,485 |
1,610 |
$318K |
| D0330 |
Panoramic radiographic image |
2,222 |
2,212 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,063 |
337 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
362 |
356 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$431.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$324.00 |
| D1110 |
Prophylaxis - adult |
77 |
77 |
$54.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$30.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
68 |
$18.00 |
| D0274 |
Bitewings - four radiographic images |
73 |
73 |
$14.40 |
| D1120 |
Prophylaxis - child |
13 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
69 |
68 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$0.00 |