| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,344 |
827 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,847 |
3,208 |
$114K |
| D1351 |
Sealant - per tooth |
4,739 |
415 |
$111K |
| D0330 |
Panoramic radiographic image |
2,614 |
2,237 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
684 |
646 |
$42K |
| D1120 |
Prophylaxis - child |
1,421 |
1,191 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,144 |
1,058 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
789 |
640 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
612 |
563 |
$13K |
| D0272 |
Bitewings - two radiographic images |
732 |
592 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,109 |
827 |
$9K |
| D7250 |
|
50 |
14 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$439.43 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
26 |
$349.12 |