| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
244 |
$5K |
| D1110 |
Prophylaxis - adult |
534 |
278 |
$4K |
| D0330 |
Panoramic radiographic image |
353 |
224 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
97 |
26 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
168 |
88 |
$1K |
| D9222 |
|
27 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
80 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
442 |
223 |
$720.00 |
| D0274 |
Bitewings - four radiographic images |
62 |
30 |
$234.00 |
| D1330 |
|
218 |
105 |
$0.00 |
| D1999 |
|
107 |
87 |
$0.00 |