| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
612 |
213 |
$38K |
| D1110 |
Prophylaxis - adult |
703 |
686 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
795 |
762 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
513 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
926 |
870 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
185 |
$8K |
| D0330 |
Panoramic radiographic image |
147 |
136 |
$7K |
| D0274 |
Bitewings - four radiographic images |
174 |
169 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
254 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
322 |
227 |
$4K |
| D0272 |
Bitewings - two radiographic images |
186 |
173 |
$3K |
| D4355 |
|
24 |
23 |
$1K |
| D1120 |
Prophylaxis - child |
65 |
62 |
$1K |