| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7510 |
|
1,630 |
468 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,367 |
396 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,796 |
1,722 |
$55K |
| D7910 |
|
1,627 |
467 |
$39K |
| D4355 |
|
547 |
523 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,493 |
1,887 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,129 |
1,993 |
$29K |
| D0330 |
Panoramic radiographic image |
618 |
579 |
$20K |
| D0274 |
Bitewings - four radiographic images |
943 |
912 |
$20K |
| D1120 |
Prophylaxis - child |
74 |
74 |
$4K |
| D7320 |
|
20 |
12 |
$2K |
| D9310 |
|
33 |
26 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
60 |
56 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$1K |
| D5899 |
|
89 |
51 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$727.04 |
| D3120 |
|
40 |
12 |
$328.00 |