| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
231 |
222 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
167 |
163 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
71 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
163 |
$5K |
| D0274 |
Bitewings - four radiographic images |
190 |
185 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
193 |
189 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
233 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80 |
77 |
$2K |