| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,071 |
335 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
709 |
673 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
744 |
701 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
591 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
895 |
851 |
$12K |
| D1110 |
Prophylaxis - adult |
521 |
488 |
$11K |
| D1120 |
Prophylaxis - child |
139 |
136 |
$6K |
| D0274 |
Bitewings - four radiographic images |
170 |
164 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
99 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
305 |
$2K |
| D1999 |
|
32 |
29 |
$0.00 |