| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,057 |
660 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
543 |
$32K |
| D1110 |
Prophylaxis - adult |
247 |
245 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
350 |
348 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
996 |
916 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
329 |
327 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
263 |
130 |
$1K |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$388.80 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$336.00 |