| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,035 |
483 |
$61K |
| D1110 |
Prophylaxis - adult |
1,364 |
1,307 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,128 |
2,045 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
739 |
666 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,234 |
1,174 |
$14K |
| D1120 |
Prophylaxis - child |
215 |
200 |
$5K |
| D2160 |
|
49 |
40 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
511 |
444 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
137 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
71 |
$1K |
| D1206 |
Topical application of fluoride varnish |
57 |
54 |
$959.75 |
| D1321 |
|
57 |
56 |
$864.75 |