| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,045 |
1,114 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
4,029 |
3,189 |
$142K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
814 |
392 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,271 |
2,728 |
$38K |
| D1120 |
Prophylaxis - child |
899 |
754 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
629 |
$21K |
| D0274 |
Bitewings - four radiographic images |
617 |
507 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
577 |
545 |
$9K |
| D1206 |
Topical application of fluoride varnish |
276 |
175 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
248 |
$3K |
| D1351 |
Sealant - per tooth |
100 |
14 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
45 |
41 |
$1K |