| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
48 |
$7K |
| D1110 |
Prophylaxis - adult |
158 |
154 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
119 |
$2K |
| D0274 |
Bitewings - four radiographic images |
78 |
77 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
57 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
49 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
92 |
89 |
$784.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
79 |
$776.00 |