| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
352 |
319 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
137 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
53 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
103 |
102 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
55 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$666.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
24 |
$0.00 |