| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,554 |
729 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
795 |
$20K |
| D1110 |
Prophylaxis - adult |
423 |
414 |
$16K |
| D0330 |
Panoramic radiographic image |
399 |
392 |
$14K |
| D0272 |
Bitewings - two radiographic images |
530 |
510 |
$8K |
| D1120 |
Prophylaxis - child |
81 |
77 |
$3K |
| D1206 |
Topical application of fluoride varnish |
238 |
235 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
98 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$897.12 |
| D9110 |
|
47 |
44 |
$839.12 |
| D0220 |
Intraoral - periapical first radiographic image |
107 |
104 |
$805.88 |