| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
886 |
282 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
752 |
747 |
$28K |
| D0330 |
Panoramic radiographic image |
448 |
446 |
$23K |
| D1110 |
Prophylaxis - adult |
489 |
476 |
$20K |
| D0274 |
Bitewings - four radiographic images |
586 |
584 |
$17K |
| D2161 |
|
64 |
33 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
96 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
244 |
241 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
426 |
421 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
145 |
$5K |
| D0180 |
|
53 |
53 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59 |
58 |
$841.40 |