| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
366 |
218 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
541 |
199 |
$48K |
| D1110 |
Prophylaxis - adult |
864 |
802 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
923 |
800 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,010 |
921 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
861 |
795 |
$18K |
| D1120 |
Prophylaxis - child |
467 |
423 |
$17K |
| D0330 |
Panoramic radiographic image |
281 |
260 |
$16K |
| D0274 |
Bitewings - four radiographic images |
429 |
400 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
258 |
243 |
$10K |
| D2140 |
|
125 |
84 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
192 |
$3K |
| D0272 |
Bitewings - two radiographic images |
61 |
60 |
$2K |