| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
17 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
118 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
287 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
66 |
$2K |
| D0274 |
Bitewings - four radiographic images |
72 |
72 |
$1K |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$895.57 |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
77 |
$798.75 |
| D2950 |
|
43 |
31 |
$786.10 |