| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
229 |
214 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
24 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
228 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
84 |
79 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
63 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
119 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
17 |
$276.00 |