| Code | Description | Claims | Beneficiaries | Total Paid |
| D7140 |
Extraction, erupted tooth or exposed root |
2,258 |
880 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
990 |
979 |
$14K |
| D0330 |
Panoramic radiographic image |
202 |
199 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
263 |
258 |
$1K |
| D1110 |
Prophylaxis - adult |
35 |
32 |
$476.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
28 |
$393.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$220.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
34 |
$202.80 |