| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,604 |
4,568 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,694 |
2,040 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
4,630 |
4,557 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,626 |
3,598 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,844 |
4,814 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
606 |
228 |
$91K |
| D0330 |
Panoramic radiographic image |
2,074 |
2,063 |
$90K |
| D7250 |
|
456 |
196 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
936 |
928 |
$42K |
| D1120 |
Prophylaxis - child |
998 |
997 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,512 |
3,451 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,199 |
1,195 |
$28K |
| D5110 |
|
38 |
38 |
$19K |
| D0274 |
Bitewings - four radiographic images |
343 |
340 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
747 |
551 |
$4K |
| D4355 |
|
25 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
60 |
12 |
$1K |