| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
185 |
184 |
$140.00 |
| D0210 |
Intraoral - complete series of radiographic images |
161 |
161 |
$58.00 |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
176 |
$39.00 |
| D2140 |
|
34 |
27 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
81 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
52 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
189 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
48 |
48 |
$0.00 |
| D1330 |
|
13 |
13 |
$0.00 |