| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,777 |
812 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
2,236 |
1,919 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
1,828 |
1,664 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
696 |
679 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
442 |
430 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,806 |
1,010 |
$9K |
| D1110 |
Prophylaxis - adult |
134 |
128 |
$4K |
| D1120 |
Prophylaxis - child |
156 |
151 |
$3K |
| D0274 |
Bitewings - four radiographic images |
120 |
115 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
41 |
$989.69 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
28 |
$960.52 |