| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
626 |
400 |
$37K |
| D1999 |
|
2,428 |
2,159 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
196 |
165 |
$19K |
| D1110 |
Prophylaxis - adult |
445 |
402 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
504 |
464 |
$9K |
| D0272 |
Bitewings - two radiographic images |
268 |
248 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
231 |
216 |
$3K |
| D0330 |
Panoramic radiographic image |
65 |
55 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
89 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
84 |
$661.23 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$310.50 |