| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
2,445 |
2,359 |
$1.17M |
| D5212 |
|
2,414 |
2,335 |
$919K |
| D5120 |
|
1,610 |
1,545 |
$764K |
| D5211 |
|
1,960 |
1,873 |
$710K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,937 |
1,035 |
$191K |
| D0140 |
Limited oral evaluation - problem focused |
7,304 |
6,651 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
521 |
230 |
$67K |
| D0330 |
Panoramic radiographic image |
1,815 |
1,700 |
$65K |
| D9110 |
|
1,450 |
1,364 |
$55K |
| D5750 |
|
320 |
306 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
1,499 |
$32K |
| D1110 |
Prophylaxis - adult |
607 |
593 |
$17K |
| D5761 |
|
113 |
108 |
$15K |
| D5640 |
|
223 |
129 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
483 |
$10K |
| D5410 |
|
266 |
260 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
654 |
625 |
$8K |
| D5760 |
|
53 |
50 |
$7K |
| D0274 |
Bitewings - four radiographic images |
280 |
275 |
$6K |
| D5650 |
|
109 |
52 |
$5K |
| D5751 |
|
38 |
36 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
438 |
$4K |
| D2140 |
|
153 |
88 |
$4K |
| D5422 |
|
126 |
123 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
75 |
62 |
$3K |
| D5512 |
|
15 |
14 |
$1K |
| D5411 |
|
28 |
28 |
$700.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$484.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
48 |
$411.00 |
| D5421 |
|
13 |
13 |
$325.00 |