| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
144 |
139 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
150 |
141 |
$6K |
| D1110 |
Prophylaxis - adult |
87 |
83 |
$5K |
| D4341 |
|
44 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
33 |
31 |
$870.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
36 |
$357.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
25 |
$220.00 |
| D0120 |
Periodic oral evaluation - established patient |
34 |
33 |
$42.00 |
| D1330 |
|
114 |
109 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |
| D1203 |
|
15 |
14 |
$0.00 |