| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
575 |
267 |
$34K |
| D1120 |
Prophylaxis - child |
1,643 |
1,238 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
881 |
786 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,116 |
768 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
760 |
440 |
$11K |
| D0272 |
Bitewings - two radiographic images |
714 |
527 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
799 |
600 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
116 |
$4K |
| D2140 |
|
95 |
40 |
$3K |