| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,274 |
1,323 |
$248K |
| D0330 |
Panoramic radiographic image |
3,071 |
2,957 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,116 |
3,976 |
$103K |
| D1110 |
Prophylaxis - adult |
1,125 |
1,085 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,673 |
1,613 |
$35K |
| D1120 |
Prophylaxis - child |
578 |
557 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
926 |
897 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
195 |
192 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
37 |
$4K |
| D9243 |
|
42 |
14 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
24 |
$1K |
| D1206 |
Topical application of fluoride varnish |
95 |
88 |
$1K |
| D9239 |
|
15 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$850.50 |