| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,418 |
542 |
$435K |
| D7140 |
Extraction, erupted tooth or exposed root |
829 |
197 |
$88K |
| D0330 |
Panoramic radiographic image |
829 |
798 |
$59K |
| D5110 |
|
76 |
76 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,347 |
654 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
732 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
662 |
$29K |
| D1110 |
Prophylaxis - adult |
601 |
548 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
623 |
582 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
498 |
218 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
347 |
321 |
$4K |
| D0274 |
Bitewings - four radiographic images |
78 |
65 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
16 |
$409.74 |