| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,398 |
1,360 |
$144K |
| D1110 |
Prophylaxis - adult |
2,458 |
2,420 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,669 |
2,575 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,725 |
2,579 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,675 |
1,611 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,411 |
1,343 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
535 |
$23K |
| D1120 |
Prophylaxis - child |
260 |
260 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
161 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
433 |
249 |
$5K |