| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,896 |
1,205 |
$242K |
| D1110 |
Prophylaxis - adult |
2,564 |
2,559 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,885 |
3,878 |
$98K |
| D0330 |
Panoramic radiographic image |
824 |
824 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
296 |
$15K |
| D0272 |
Bitewings - two radiographic images |
689 |
689 |
$9K |
| D1120 |
Prophylaxis - child |
204 |
204 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
712 |
704 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
151 |
151 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
442 |
179 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$309.00 |