| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
171 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
41 |
$2K |
| D1110 |
Prophylaxis - adult |
56 |
56 |
$2K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
66 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
79 |
79 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
155 |
$788.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$530.40 |