| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,630 |
2,656 |
$353K |
| D0330 |
Panoramic radiographic image |
3,108 |
2,214 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,283 |
1,543 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
223 |
165 |
$27K |
| D0274 |
Bitewings - four radiographic images |
820 |
599 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
986 |
775 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,440 |
1,091 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
950 |
743 |
$12K |
| D1110 |
Prophylaxis - adult |
413 |
275 |
$12K |
| D5211 |
|
15 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
32 |
13 |
$195.06 |