| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
69 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
194 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
176 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
274 |
$4K |
| D0330 |
Panoramic radiographic image |
33 |
32 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
25 |
$921.43 |
| D0274 |
Bitewings - four radiographic images |
142 |
141 |
$861.47 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
12 |
$224.10 |