| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,288 |
1,745 |
$179K |
| D1110 |
Prophylaxis - adult |
2,789 |
2,730 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,864 |
1,835 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,113 |
2,071 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,916 |
1,880 |
$38K |
| D0330 |
Panoramic radiographic image |
710 |
691 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
963 |
745 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,201 |
1,183 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
336 |
268 |
$18K |
| D1120 |
Prophylaxis - child |
718 |
703 |
$16K |
| D2140 |
|
345 |
251 |
$13K |
| D5214 |
|
12 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,344 |
1,267 |
$6K |
| D0272 |
Bitewings - two radiographic images |
404 |
398 |
$4K |
| D5110 |
|
12 |
12 |
$4K |
| D5120 |
|
12 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
130 |
$3K |
| D1351 |
Sealant - per tooth |
66 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
28 |
$155.00 |
| D0350 |
|
16 |
16 |
$147.72 |
| D1999 |
|
18 |
17 |
$0.00 |