| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,410 |
1,589 |
$492K |
| D0210 |
Intraoral - complete series of radiographic images |
1,796 |
1,670 |
$123K |
| D1110 |
Prophylaxis - adult |
2,763 |
2,473 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
3,837 |
3,084 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,775 |
3,424 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
2,328 |
1,935 |
$35K |
| D5110 |
|
132 |
64 |
$31K |
| D0330 |
Panoramic radiographic image |
624 |
548 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,028 |
845 |
$18K |
| D0272 |
Bitewings - two radiographic images |
854 |
761 |
$18K |
| D4341 |
|
148 |
59 |
$13K |
| D5120 |
|
52 |
25 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
303 |
275 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
28 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
43 |
$4K |
| D2140 |
|
19 |
13 |
$1K |
| D2160 |
|
14 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
103 |
90 |
$807.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$142.50 |
| D0431 |
|
147 |
115 |
$0.00 |
| D1999 |
|
13 |
12 |
$0.00 |