| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
25,986 |
11,276 |
$1.77M |
| D5110 |
|
2,303 |
2,268 |
$938K |
| D5120 |
|
1,905 |
1,874 |
$773K |
| D1120 |
Prophylaxis - child |
6,214 |
6,017 |
$254K |
| D0330 |
Panoramic radiographic image |
10,612 |
10,350 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
8,658 |
8,400 |
$242K |
| D0140 |
Limited oral evaluation - problem focused |
13,169 |
12,541 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,434 |
6,234 |
$167K |
| D1351 |
Sealant - per tooth |
2,247 |
1,118 |
$165K |
| D1110 |
Prophylaxis - adult |
1,328 |
1,301 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
572 |
503 |
$35K |
| D0272 |
Bitewings - two radiographic images |
291 |
291 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
93 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$67.20 |