| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,692 |
1,216 |
$151K |
| D1110 |
Prophylaxis - adult |
3,185 |
3,159 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,199 |
488 |
$66K |
| D0330 |
Panoramic radiographic image |
2,104 |
2,088 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,644 |
2,621 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,722 |
1,707 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,870 |
1,851 |
$40K |
| D5110 |
|
92 |
89 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,596 |
2,524 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,162 |
1,154 |
$18K |
| D5214 |
|
26 |
25 |
$14K |
| D5120 |
|
24 |
24 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,095 |
1,509 |
$10K |
| D5213 |
|
14 |
13 |
$9K |
| D1120 |
Prophylaxis - child |
162 |
162 |
$6K |
| D7230 |
|
37 |
25 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
198 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
77 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
13 |
$812.08 |
| D2140 |
|
19 |
13 |
$701.35 |