| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
64 |
$17K |
| D1110 |
Prophylaxis - adult |
324 |
259 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
273 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
97 |
$8K |
| D0274 |
Bitewings - four radiographic images |
183 |
149 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
190 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
207 |
165 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
25 |
24 |
$673.20 |
| D1999 |
|
158 |
78 |
$0.00 |
| D0431 |
|
16 |
16 |
$0.00 |