| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,035 |
969 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
825 |
274 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,204 |
2,054 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
455 |
227 |
$23K |
| D1120 |
Prophylaxis - child |
483 |
442 |
$19K |
| D0274 |
Bitewings - four radiographic images |
870 |
804 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
896 |
819 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
358 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,693 |
1,322 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
108 |
60 |
$7K |
| D1110 |
Prophylaxis - adult |
307 |
286 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
378 |
$4K |
| D2140 |
|
64 |
41 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$3K |
| D0272 |
Bitewings - two radiographic images |
188 |
167 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
54 |
$2K |