| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,125 |
489 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
803 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
159 |
117 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
545 |
492 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
108 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
130 |
$1K |
| D1110 |
Prophylaxis - adult |
17 |
12 |
$615.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$248.60 |