| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,696 |
713 |
$55K |
| D1110 |
Prophylaxis - adult |
1,280 |
1,268 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,041 |
1,029 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
1,029 |
997 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
815 |
806 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
916 |
906 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,550 |
1,510 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,471 |
928 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
194 |
192 |
$2K |
| D0274 |
Bitewings - four radiographic images |
120 |
119 |
$1K |
| D0603 |
|
236 |
236 |
$880.00 |
| D0602 |
|
170 |
167 |
$676.00 |
| D1330 |
|
355 |
353 |
$0.00 |