| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,035 |
1,440 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
629 |
627 |
$40K |
| D1110 |
Prophylaxis - adult |
422 |
421 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
290 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
89 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,013 |
975 |
$12K |
| D9430 |
|
300 |
294 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
45 |
$465.10 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$390.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$120.00 |