| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
148 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
586 |
243 |
$5K |
| D1110 |
Prophylaxis - adult |
133 |
130 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
327 |
291 |
$3K |
| D0272 |
Bitewings - two radiographic images |
205 |
200 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
39 |
$981.50 |
| D0120 |
Periodic oral evaluation - established patient |
27 |
27 |
$616.16 |