| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
332 |
134 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
134 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
111 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
28 |
$0.00 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$0.00 |