| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
628 |
214 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
643 |
642 |
$17K |
| D1110 |
Prophylaxis - adult |
433 |
432 |
$16K |
| D1120 |
Prophylaxis - child |
294 |
293 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
396 |
394 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
323 |
323 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
308 |
308 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
585 |
579 |
$6K |
| D0274 |
Bitewings - four radiographic images |
156 |
156 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
251 |
$2K |
| D4355 |
|
27 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
32 |
31 |
$2K |