| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
457 |
337 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
764 |
751 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
915 |
888 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
91 |
$17K |
| D1120 |
Prophylaxis - child |
393 |
379 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
681 |
665 |
$15K |
| D1206 |
Topical application of fluoride varnish |
389 |
370 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
135 |
$2K |
| D1110 |
Prophylaxis - adult |
67 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
322 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$239.28 |
| D0270 |
|
12 |
12 |
$67.20 |