| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,266 |
1,603 |
$283K |
| D1110 |
Prophylaxis - adult |
2,546 |
2,537 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,746 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,555 |
2,539 |
$48K |
| D1120 |
Prophylaxis - child |
949 |
942 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,688 |
1,677 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
940 |
931 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,087 |
2,037 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
603 |
602 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
239 |
184 |
$14K |
| D0330 |
Panoramic radiographic image |
144 |
144 |
$6K |
| D2140 |
|
113 |
80 |
$5K |
| D1206 |
Topical application of fluoride varnish |
137 |
137 |
$4K |
| D2330 |
|
39 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
17 |
$106.80 |