| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,045 |
984 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
82 |
$14K |
| D0330 |
Panoramic radiographic image |
151 |
143 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
491 |
456 |
$10K |
| D1110 |
Prophylaxis - adult |
138 |
135 |
$10K |
| D0274 |
Bitewings - four radiographic images |
100 |
98 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
73 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$828.68 |