| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
508 |
194 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
437 |
177 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
437 |
421 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
333 |
$13K |
| D2160 |
|
84 |
48 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
605 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
169 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
377 |
$4K |
| D2140 |
|
40 |
24 |
$3K |
| D2950 |
|
24 |
18 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
40 |
$915.11 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$678.72 |