| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,553 |
894 |
$86K |
| D1110 |
Prophylaxis - adult |
1,626 |
1,624 |
$82K |
| D2335 |
|
380 |
162 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,642 |
1,640 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,144 |
2,046 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,494 |
1,490 |
$18K |
| D2161 |
|
96 |
56 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
132 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$1K |