| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
198 |
185 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,130 |
788 |
$69K |
| D1110 |
Prophylaxis - adult |
1,875 |
1,808 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,638 |
2,495 |
$40K |
| D0330 |
Panoramic radiographic image |
1,175 |
1,119 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
500 |
299 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,923 |
1,819 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
937 |
881 |
$32K |
| D5120 |
|
63 |
63 |
$25K |
| D5211 |
|
63 |
57 |
$19K |
| D0274 |
Bitewings - four radiographic images |
987 |
908 |
$14K |
| D5212 |
|
43 |
38 |
$13K |
| D9110 |
|
602 |
517 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
997 |
969 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
754 |
702 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
911 |
847 |
$6K |
| D1120 |
Prophylaxis - child |
186 |
174 |
$4K |
| D2335 |
|
54 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
219 |
$2K |
| D0272 |
Bitewings - two radiographic images |
108 |
102 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
27 |
$1K |
| D2140 |
|
16 |
12 |
$526.50 |
| D0170 |
|
22 |
18 |
$256.48 |