| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
2,764 |
1,920 |
$235K |
| D0330 |
Panoramic radiographic image |
1,059 |
848 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
502 |
422 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
130 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
13 |
$856.54 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
54 |
$91.26 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
579 |
538 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
18 |
$0.00 |