| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,718 |
932 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
1,031 |
1,021 |
$27K |
| D1110 |
Prophylaxis - adult |
539 |
539 |
$17K |
| D9310 |
|
455 |
443 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
896 |
$9K |
| D0330 |
Panoramic radiographic image |
205 |
205 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
257 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
268 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
90 |
90 |
$4K |
| D0274 |
Bitewings - four radiographic images |
80 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
40 |
$736.16 |