| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,610 |
796 |
$129K |
| D1120 |
Prophylaxis - child |
1,565 |
1,527 |
$76K |
| D1206 |
Topical application of fluoride varnish |
1,561 |
1,520 |
$49K |
| D1351 |
Sealant - per tooth |
972 |
334 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,264 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
942 |
$19K |
| D1110 |
Prophylaxis - adult |
163 |
163 |
$11K |
| D1354 |
|
339 |
127 |
$11K |
| D0274 |
Bitewings - four radiographic images |
299 |
293 |
$9K |
| D0330 |
Panoramic radiographic image |
274 |
274 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
287 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
255 |
249 |
$2K |
| D1999 |
|
38 |
38 |
$0.00 |
| D0603 |
|
369 |
257 |
$0.00 |
| D0602 |
|
494 |
353 |
$0.00 |
| D0601 |
|
928 |
697 |
$0.00 |