| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,107 |
645 |
$291K |
| D0140 |
Limited oral evaluation - problem focused |
2,235 |
1,448 |
$63K |
| D0330 |
Panoramic radiographic image |
1,169 |
924 |
$46K |
| D0274 |
Bitewings - four radiographic images |
590 |
426 |
$12K |
| D1120 |
Prophylaxis - child |
214 |
156 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
456 |
274 |
$4K |
| D1351 |
Sealant - per tooth |
121 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
45 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
76 |
64 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
73 |
$1K |