| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
223 |
214 |
$6K |
| D0274 |
Bitewings - four radiographic images |
235 |
230 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
241 |
235 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
58 |
$3K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
54 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$502.93 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$499.95 |