| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
999 |
415 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
2,143 |
1,951 |
$55K |
| D1110 |
Prophylaxis - adult |
739 |
707 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,159 |
1,110 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,814 |
1,040 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
289 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,610 |
1,480 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
392 |
363 |
$7K |
| D1320 |
|
78 |
65 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
122 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$960.90 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$231.00 |