| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,009 |
806 |
$177K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,780 |
854 |
$104K |
| D1110 |
Prophylaxis - adult |
2,516 |
2,464 |
$91K |
| D0330 |
Panoramic radiographic image |
1,525 |
1,485 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,581 |
2,538 |
$48K |
| D2160 |
|
568 |
339 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,027 |
1,990 |
$43K |
| D2331 |
|
393 |
103 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
773 |
743 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
702 |
685 |
$11K |
| D5110 |
|
27 |
26 |
$10K |
| D2140 |
|
248 |
118 |
$10K |
| D5120 |
|
14 |
13 |
$5K |
| D1120 |
Prophylaxis - child |
237 |
234 |
$4K |
| D0272 |
Bitewings - two radiographic images |
339 |
333 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
121 |
118 |
$3K |
| D1321 |
|
105 |
100 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
76 |
$343.00 |