| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,944 |
1,268 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,498 |
2,354 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,787 |
1,700 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,614 |
2,355 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,385 |
1,189 |
$7K |
| D1120 |
Prophylaxis - child |
143 |
133 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
138 |
$4K |
| D1110 |
Prophylaxis - adult |
59 |
52 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
56 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$863.05 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$334.90 |