| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,633 |
1,631 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,537 |
1,528 |
$23K |
| D4341 |
|
484 |
165 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
444 |
444 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
41 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
46 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
206 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
308 |
305 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
507 |
506 |
$3K |
| D0274 |
Bitewings - four radiographic images |
52 |
52 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
72 |
$917.60 |
| D5422 |
|
14 |
13 |
$226.00 |
| D1999 |
|
15 |
13 |
$0.00 |