| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,856 |
2,419 |
$227K |
| D1110 |
Prophylaxis - adult |
4,450 |
4,204 |
$122K |
| D0330 |
Panoramic radiographic image |
2,311 |
2,184 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,187 |
3,011 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,728 |
3,520 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,915 |
2,781 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
820 |
619 |
$39K |
| D2140 |
|
917 |
641 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,738 |
1,667 |
$24K |
| D1120 |
Prophylaxis - child |
1,100 |
1,057 |
$20K |
| D5214 |
|
32 |
25 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,913 |
2,631 |
$9K |
| D0272 |
Bitewings - two radiographic images |
789 |
759 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
320 |
301 |
$4K |
| D5110 |
|
14 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
721 |
498 |
$2K |
| D2335 |
|
13 |
12 |
$1K |
| D2331 |
|
15 |
12 |
$822.37 |
| D0350 |
|
45 |
42 |
$443.16 |
| D0470 |
|
27 |
27 |
$374.34 |
| D1999 |
|
17 |
17 |
$0.00 |