| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
730 |
672 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
761 |
216 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
752 |
668 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
368 |
$10K |
| D1110 |
Prophylaxis - adult |
465 |
424 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
483 |
434 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
169 |
135 |
$994.87 |
| D1120 |
Prophylaxis - child |
21 |
21 |
$945.00 |
| D0274 |
Bitewings - four radiographic images |
27 |
26 |
$601.47 |