| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
870 |
407 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,459 |
1,356 |
$43K |
| D0330 |
Panoramic radiographic image |
1,174 |
1,113 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
852 |
303 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,265 |
1,208 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,192 |
1,135 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,796 |
1,643 |
$14K |
| D1110 |
Prophylaxis - adult |
373 |
364 |
$14K |
| D1120 |
Prophylaxis - child |
196 |
186 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
148 |
90 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
458 |
431 |
$7K |
| D9110 |
|
157 |
149 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
709 |
378 |
$3K |
| D2332 |
|
40 |
16 |
$2K |
| D2140 |
|
42 |
25 |
$1K |
| D1351 |
Sealant - per tooth |
53 |
15 |
$910.65 |
| D2160 |
|
13 |
12 |
$748.61 |