| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,459 |
502 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,441 |
1,286 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,112 |
997 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
587 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
54 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
232 |
206 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
223 |
218 |
$3K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$524.51 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$237.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
15 |
$147.90 |