| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,328 |
721 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,796 |
1,708 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
349 |
263 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
1,778 |
1,686 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
197 |
197 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
240 |
240 |
$3K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$2K |
| D0272 |
Bitewings - two radiographic images |
90 |
90 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$728.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
101 |
80 |
$628.68 |