| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
98 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
177 |
$7K |
| D0274 |
Bitewings - four radiographic images |
142 |
142 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
312 |
307 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
171 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$2K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
101 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$603.36 |