| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,196 |
804 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,534 |
905 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
3,544 |
3,203 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,372 |
4,054 |
$16K |
| D0330 |
Panoramic radiographic image |
311 |
295 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
529 |
518 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
979 |
900 |
$3K |
| D2950 |
|
28 |
27 |
$1K |
| D0274 |
Bitewings - four radiographic images |
262 |
258 |
$1K |
| D7250 |
|
55 |
37 |
$1K |
| D1110 |
Prophylaxis - adult |
82 |
81 |
$755.52 |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
175 |
$592.54 |
| D1120 |
Prophylaxis - child |
13 |
12 |
$274.36 |