| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
113 |
$3K |
| D1110 |
Prophylaxis - adult |
61 |
58 |
$2K |
| D0330 |
Panoramic radiographic image |
94 |
91 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
172 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
24 |
$568.93 |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
109 |
$134.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
312 |
71 |
$22.36 |
| D9630 |
|
91 |
72 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$0.00 |