| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,719 |
807 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
1,013 |
1,012 |
$36K |
| D0330 |
Panoramic radiographic image |
414 |
414 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
794 |
783 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
221 |
$8K |
| D1110 |
Prophylaxis - adult |
107 |
107 |
$5K |
| D0272 |
Bitewings - two radiographic images |
235 |
235 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$440.16 |