| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,089 |
1,994 |
$205K |
| D0274 |
Bitewings - four radiographic images |
1,646 |
1,589 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
429 |
334 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,574 |
1,527 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
837 |
799 |
$36K |
| D7250 |
|
192 |
148 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
622 |
585 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
1,483 |
$17K |
| D1110 |
Prophylaxis - adult |
150 |
140 |
$7K |
| D5110 |
|
12 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
123 |
107 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
105 |
$467.17 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$278.59 |