| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,049 |
681 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,256 |
386 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,335 |
1,332 |
$72K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
733 |
476 |
$48K |
| D1110 |
Prophylaxis - adult |
625 |
619 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
944 |
942 |
$41K |
| D5130 |
|
62 |
62 |
$39K |
| D1120 |
Prophylaxis - child |
1,069 |
1,065 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
473 |
473 |
$20K |
| D2160 |
|
228 |
174 |
$18K |
| D0274 |
Bitewings - four radiographic images |
622 |
619 |
$12K |
| D2140 |
|
238 |
160 |
$12K |
| D0330 |
Panoramic radiographic image |
293 |
292 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,930 |
967 |
$8K |
| D5140 |
|
13 |
12 |
$7K |
| D0350 |
|
777 |
397 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
967 |
963 |
$6K |
| D9430 |
|
275 |
274 |
$6K |
| D5850 |
|
37 |
37 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
170 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |
| D0140 |
Limited oral evaluation - problem focused |
93 |
93 |
$0.00 |