| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,251 |
2,322 |
$329K |
| D0210 |
Intraoral - complete series of radiographic images |
2,377 |
2,046 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,520 |
2,185 |
$100K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
881 |
679 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,246 |
2,712 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,993 |
1,577 |
$41K |
| D1110 |
Prophylaxis - adult |
866 |
757 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,398 |
2,720 |
$32K |
| D1120 |
Prophylaxis - child |
218 |
218 |
$6K |
| D0272 |
Bitewings - two radiographic images |
300 |
292 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
308 |
308 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
624 |
425 |
$4K |