| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,307 |
1,480 |
$151K |
| D1110 |
Prophylaxis - adult |
2,028 |
1,927 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,566 |
2,425 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,521 |
1,473 |
$53K |
| D0274 |
Bitewings - four radiographic images |
951 |
902 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,546 |
1,456 |
$24K |
| D1120 |
Prophylaxis - child |
454 |
437 |
$13K |
| D0330 |
Panoramic radiographic image |
176 |
166 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
129 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
300 |
$4K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$216.48 |