| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,497 |
4,193 |
$515K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,313 |
1,739 |
$386K |
| D0330 |
Panoramic radiographic image |
6,471 |
6,188 |
$272K |
| D0140 |
Limited oral evaluation - problem focused |
3,689 |
3,548 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,899 |
3,661 |
$100K |
| D2140 |
|
2,511 |
1,303 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,718 |
1,148 |
$83K |
| D1110 |
Prophylaxis - adult |
1,820 |
1,704 |
$76K |
| D9110 |
|
1,451 |
1,361 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,530 |
5,218 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,022 |
2,831 |
$44K |
| D5110 |
|
63 |
62 |
$41K |
| D2332 |
|
526 |
308 |
$33K |
| D1120 |
Prophylaxis - child |
546 |
512 |
$26K |
| D2331 |
|
306 |
200 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,042 |
976 |
$15K |
| D2160 |
|
304 |
178 |
$14K |
| D5120 |
|
13 |
13 |
$8K |
| D0274 |
Bitewings - four radiographic images |
235 |
227 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
231 |
183 |
$1K |