| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
123 |
111 |
$3K |
| D0274 |
Bitewings - four radiographic images |
174 |
161 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
96 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
181 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
219 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
59 |
$911.40 |
| D0120 |
Periodic oral evaluation - established patient |
45 |
38 |
$509.08 |
| D1999 |
|
94 |
82 |
$0.00 |