| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
226 |
218 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
111 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
139 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
31 |
30 |
$958.24 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$858.04 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
52 |
$270.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$240.00 |