| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
865 |
837 |
$23K |
| D0330 |
Panoramic radiographic image |
503 |
490 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
781 |
757 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
603 |
$11K |
| D0274 |
Bitewings - four radiographic images |
920 |
885 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
400 |
385 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
209 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
718 |
686 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
283 |
158 |
$930.40 |
| D0270 |
|
59 |
57 |
$346.00 |