| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
500 |
482 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
323 |
196 |
$8K |
| D0330 |
Panoramic radiographic image |
130 |
125 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
299 |
$2K |
| D1110 |
Prophylaxis - adult |
31 |
26 |
$747.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
20 |
$473.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
21 |
$197.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
33 |
$84.60 |
| D1999 |
|
94 |
89 |
$0.00 |