| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,644 |
533 |
$133K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
556 |
326 |
$98K |
| D1110 |
Prophylaxis - adult |
1,661 |
1,521 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,731 |
1,595 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,747 |
1,603 |
$38K |
| D0274 |
Bitewings - four radiographic images |
937 |
864 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
931 |
850 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,543 |
1,411 |
$30K |
| D1120 |
Prophylaxis - child |
797 |
736 |
$24K |
| D0330 |
Panoramic radiographic image |
237 |
225 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
710 |
648 |
$9K |
| D2140 |
|
111 |
75 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
17 |
$209.00 |