| Code | Description | Claims | Beneficiaries | Total Paid |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,145 |
1,434 |
$473K |
| D9239 |
|
2,976 |
2,963 |
$372K |
| D9243 |
|
5,034 |
2,966 |
$370K |
| D7230 |
|
1,447 |
637 |
$237K |
| D7240 |
Removal of impacted tooth - completely bony |
1,203 |
431 |
$221K |
| D0140 |
Limited oral evaluation - problem focused |
3,373 |
3,314 |
$99K |
| D9610 |
|
2,904 |
2,893 |
$74K |
| D0330 |
Panoramic radiographic image |
1,163 |
1,159 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
71 |
$16K |
| D1110 |
Prophylaxis - adult |
274 |
274 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
354 |
$6K |
| D0274 |
Bitewings - four radiographic images |
217 |
216 |
$6K |
| D7220 |
|
37 |
26 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
150 |
150 |
$3K |
| D9920 |
|
13 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$818.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$137.99 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |