| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,051 |
1,003 |
$572K |
| D5110 |
|
818 |
802 |
$503K |
| D5120 |
|
582 |
568 |
$399K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,753 |
828 |
$214K |
| D5140 |
|
263 |
256 |
$74K |
| D0330 |
Panoramic radiographic image |
2,072 |
2,036 |
$72K |
| D5130 |
|
278 |
270 |
$71K |
| D7310 |
|
910 |
460 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,108 |
2,063 |
$34K |
| D5214 |
|
295 |
293 |
$27K |
| D7473 |
|
213 |
117 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
379 |
$9K |
| D0170 |
|
409 |
384 |
$8K |
| D9992 |
|
247 |
239 |
$2K |
| D5213 |
|
175 |
175 |
$0.00 |
| D2950 |
|
248 |
109 |
$0.00 |
| D4341 |
|
605 |
170 |
$0.00 |
| D7880 |
|
435 |
435 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
147 |
$0.00 |
| D1110 |
Prophylaxis - adult |
62 |
62 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
293 |
$0.00 |
| D2750 |
|
323 |
116 |
$0.00 |
| D9920 |
|
64 |
61 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
64 |
$0.00 |
| D2335 |
|
27 |
15 |
$0.00 |
| D5730 |
|
14 |
14 |
$0.00 |