| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,279 |
1,351 |
$339K |
| D0140 |
Limited oral evaluation - problem focused |
2,740 |
2,657 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
3,433 |
3,282 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,375 |
1,884 |
$40K |
| D0274 |
Bitewings - four radiographic images |
736 |
736 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
658 |
658 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
653 |
653 |
$8K |
| D1120 |
Prophylaxis - child |
149 |
149 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$900.00 |