| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
436 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,598 |
422 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
627 |
$2K |
| D1110 |
Prophylaxis - adult |
78 |
76 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
154 |
$811.20 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
25 |
$524.80 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$342.00 |
| D0274 |
Bitewings - four radiographic images |
87 |
86 |
$301.00 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
24 |
$171.00 |