| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,473 |
731 |
$58K |
| D0330 |
Panoramic radiographic image |
1,222 |
1,187 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,274 |
1,218 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
600 |
$16K |
| D0274 |
Bitewings - four radiographic images |
572 |
557 |
$13K |
| D1110 |
Prophylaxis - adult |
279 |
267 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
65 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
363 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$545.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
25 |
$230.28 |
| D9986 |
|
203 |
176 |
$150.00 |
| D1999 |
|
1,350 |
1,215 |
$0.00 |