| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
596 |
310 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
730 |
590 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
208 |
194 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
84 |
81 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
59 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
85 |
80 |
$0.00 |
| D0330 |
Panoramic radiographic image |
112 |
102 |
$0.00 |
| D1110 |
Prophylaxis - adult |
127 |
120 |
$0.00 |