| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,372 |
5,012 |
$670K |
| D1110 |
Prophylaxis - adult |
9,886 |
8,369 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
10,699 |
9,207 |
$262K |
| D0274 |
Bitewings - four radiographic images |
5,506 |
4,503 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,867 |
2,472 |
$118K |
| D1120 |
Prophylaxis - child |
2,065 |
2,045 |
$70K |
| D0330 |
Panoramic radiographic image |
2,405 |
1,957 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,505 |
4,530 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,886 |
2,866 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,933 |
2,773 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
262 |
193 |
$27K |
| D2140 |
|
400 |
251 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
198 |
135 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
62 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$566.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
29 |
$389.35 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$242.90 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$173.59 |