| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
933 |
641 |
$44K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,510 |
$44K |
| D1999 |
|
2,443 |
2,052 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
855 |
721 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
774 |
688 |
$13K |
| D0272 |
Bitewings - two radiographic images |
832 |
735 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
654 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
849 |
751 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
335 |
264 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
145 |
94 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D2140 |
|
85 |
44 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
24 |
$388.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
14 |
$147.56 |