| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
407 |
186 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
264 |
82 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
393 |
$6K |
| D1120 |
Prophylaxis - child |
141 |
141 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
172 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
421 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
202 |
191 |
$3K |
| D1110 |
Prophylaxis - adult |
72 |
71 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
134 |
134 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
93 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
70 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
79 |
79 |
$2K |
| D1999 |
|
15 |
14 |
$0.00 |