| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,787 |
1,772 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
371 |
187 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
466 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
989 |
975 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
567 |
558 |
$20K |
| D0274 |
Bitewings - four radiographic images |
571 |
564 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,243 |
1,224 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
59 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
345 |
$13K |
| D1120 |
Prophylaxis - child |
228 |
226 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
999 |
683 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
50 |
$5K |
| D1206 |
Topical application of fluoride varnish |
180 |
179 |
$5K |
| D0330 |
Panoramic radiographic image |
34 |
33 |
$2K |