| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
282 |
155 |
$38K |
| D1110 |
Prophylaxis - adult |
621 |
613 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
284 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
555 |
546 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
301 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
782 |
522 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
621 |
$10K |
| D0272 |
Bitewings - two radiographic images |
316 |
313 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
272 |
269 |
$8K |
| D1120 |
Prophylaxis - child |
68 |
65 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$2K |
| D9110 |
|
30 |
26 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$456.00 |