| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
173 |
$31K |
| D1110 |
Prophylaxis - adult |
547 |
542 |
$26K |
| D0330 |
Panoramic radiographic image |
469 |
458 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,043 |
1,040 |
$22K |
| D1320 |
|
592 |
562 |
$21K |
| D1206 |
Topical application of fluoride varnish |
831 |
824 |
$15K |
| D0274 |
Bitewings - four radiographic images |
387 |
387 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
339 |
337 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
48 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
490 |
471 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
658 |
292 |
$5K |
| D1120 |
Prophylaxis - child |
171 |
171 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
122 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
245 |
$4K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$244.02 |