| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,578 |
756 |
$334K |
| D5110 |
|
242 |
152 |
$108K |
| D7250 |
|
676 |
107 |
$88K |
| D5120 |
|
121 |
83 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
286 |
102 |
$36K |
| D0330 |
Panoramic radiographic image |
641 |
531 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
917 |
756 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
222 |
$13K |
| D1110 |
Prophylaxis - adult |
343 |
266 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
426 |
361 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
166 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
287 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
107 |
68 |
$2K |
| D1206 |
Topical application of fluoride varnish |
77 |
77 |
$2K |
| D1330 |
|
20 |
20 |
$0.00 |
| D0350 |
|
25 |
25 |
$0.00 |