| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
833 |
803 |
$28K |
| D1110 |
Prophylaxis - adult |
628 |
611 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
768 |
743 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
283 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
439 |
419 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
795 |
749 |
$6K |
| D0272 |
Bitewings - two radiographic images |
254 |
241 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$535.00 |
| D9986 |
|
54 |
51 |
$0.00 |