| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
690 |
684 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
966 |
958 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
501 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
218 |
$10K |
| D1120 |
Prophylaxis - child |
104 |
103 |
$4K |
| D0330 |
Panoramic radiographic image |
115 |
115 |
$3K |
| D9430 |
|
97 |
96 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
19 |
$264.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$110.00 |