| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,010 |
245 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
105 |
58 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
183 |
$6K |
| D0330 |
Panoramic radiographic image |
123 |
121 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
143 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
159 |
$3K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
67 |
$1K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$892.88 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$511.17 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$211.25 |