| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,506 |
387 |
$146K |
| D7240 |
Removal of impacted tooth - completely bony |
411 |
195 |
$146K |
| D9243 |
|
572 |
571 |
$143K |
| D9239 |
|
476 |
475 |
$41K |
| D7230 |
|
83 |
45 |
$16K |
| D0160 |
|
379 |
379 |
$10K |
| D7250 |
|
161 |
46 |
$10K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$371.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$359.10 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$341.05 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$226.10 |
| D9610 |
|
14 |
14 |
$190.19 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$139.65 |