| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,213 |
1,117 |
$110K |
| D0274 |
Bitewings - four radiographic images |
263 |
255 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
24 |
12 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
189 |
$8K |
| D1110 |
Prophylaxis - adult |
217 |
211 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
13 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
142 |
140 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
868 |
429 |
$2K |