| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,880 |
1,790 |
$261K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,371 |
1,120 |
$167K |
| D0330 |
Panoramic radiographic image |
3,702 |
3,533 |
$157K |
| D0140 |
Limited oral evaluation - problem focused |
3,431 |
3,239 |
$109K |
| D9110 |
|
1,082 |
1,056 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,735 |
$45K |
| D1110 |
Prophylaxis - adult |
1,073 |
1,032 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,105 |
2,862 |
$22K |
| D7250 |
|
155 |
54 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,228 |
1,272 |
$10K |
| D5110 |
|
13 |
13 |
$8K |
| D0274 |
Bitewings - four radiographic images |
282 |
279 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
39 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
66 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
14 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
90 |
$2K |
| D2335 |
|
22 |
12 |
$2K |
| D2332 |
|
26 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$524.33 |