| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,127 |
712 |
$97K |
| D9999 |
Unspecified adjunctive procedure, by report |
373 |
324 |
$54K |
| D0330 |
Panoramic radiographic image |
971 |
970 |
$33K |
| D0160 |
|
771 |
770 |
$21K |
| D9243 |
|
90 |
89 |
$13K |
| D9310 |
|
77 |
77 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
122 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
128 |
127 |
$470.74 |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$96.46 |
| D0120 |
Periodic oral evaluation - established patient |
42 |
42 |
$25.78 |
| D0274 |
Bitewings - four radiographic images |
23 |
23 |
$13.78 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$4.04 |
| D1310 |
|
17 |
17 |
$0.00 |
| D1330 |
|
135 |
131 |
$0.00 |
| D4355 |
|
24 |
24 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$0.00 |
| D1120 |
Prophylaxis - child |
57 |
57 |
$0.00 |
| D1999 |
|
16 |
15 |
$0.00 |