| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,304 |
1,604 |
$72K |
| D1120 |
Prophylaxis - child |
2,253 |
1,668 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,295 |
1,117 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
855 |
467 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
90 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,203 |
889 |
$11K |
| D0272 |
Bitewings - two radiographic images |
437 |
360 |
$8K |
| D0330 |
Panoramic radiographic image |
49 |
37 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
13 |
$238.17 |