| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,225 |
1,258 |
$213K |
| D0140 |
Limited oral evaluation - problem focused |
1,983 |
1,912 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,568 |
2,568 |
$54K |
| D1120 |
Prophylaxis - child |
1,791 |
1,791 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
355 |
163 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,247 |
2,247 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,605 |
1,605 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,804 |
1,758 |
$27K |
| D1110 |
Prophylaxis - adult |
420 |
420 |
$19K |
| D2140 |
|
70 |
39 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
444 |
313 |
$3K |