| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
294 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
262 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,032 |
976 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
460 |
217 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
27 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,301 |
371 |
$1K |
| D0272 |
Bitewings - two radiographic images |
105 |
102 |
$877.90 |
| D1110 |
Prophylaxis - adult |
42 |
39 |
$409.53 |