| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
859 |
368 |
$55K |
| D1110 |
Prophylaxis - adult |
1,082 |
1,072 |
$32K |
| D0330 |
Panoramic radiographic image |
759 |
751 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,076 |
1,062 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
879 |
862 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
819 |
724 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
680 |
674 |
$7K |
| D0272 |
Bitewings - two radiographic images |
435 |
429 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$126.00 |