| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
905 |
329 |
$62K |
| D1110 |
Prophylaxis - adult |
1,244 |
1,227 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,455 |
2,427 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
2,072 |
$35K |
| D1120 |
Prophylaxis - child |
870 |
859 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,163 |
2,067 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
556 |
550 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,187 |
477 |
$13K |
| D0274 |
Bitewings - four radiographic images |
364 |
361 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
39 |
$3K |
| D0272 |
Bitewings - two radiographic images |
122 |
122 |
$2K |
| D1351 |
Sealant - per tooth |
68 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$1K |