| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,749 |
695 |
$121K |
| D1110 |
Prophylaxis - adult |
1,756 |
1,729 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,502 |
2,438 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,390 |
1,364 |
$35K |
| D1120 |
Prophylaxis - child |
1,157 |
1,115 |
$30K |
| D0330 |
Panoramic radiographic image |
403 |
392 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
646 |
611 |
$19K |
| D1206 |
Topical application of fluoride varnish |
730 |
691 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
485 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
735 |
727 |
$11K |
| D0272 |
Bitewings - two radiographic images |
631 |
608 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,015 |
947 |
$6K |
| D2330 |
|
24 |
14 |
$1K |
| D2332 |
|
17 |
12 |
$1K |
| D2140 |
|
19 |
13 |
$798.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$793.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
25 |
$236.25 |