| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5226 |
|
383 |
374 |
$293K |
| D5225 |
|
339 |
333 |
$254K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
331 |
113 |
$52K |
| D5110 |
|
52 |
50 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
403 |
$26K |
| D1110 |
Prophylaxis - adult |
505 |
499 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
625 |
614 |
$15K |
| D5120 |
|
16 |
15 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
692 |
223 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
227 |
$4K |
| D0274 |
Bitewings - four radiographic images |
68 |
67 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
64 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$622.10 |