| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
1,230 |
1,182 |
$529K |
| D5120 |
|
818 |
795 |
$334K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,296 |
256 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,592 |
2,537 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,132 |
1,080 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
457 |
134 |
$48K |
| D5212 |
|
85 |
84 |
$30K |
| D5750 |
|
158 |
157 |
$21K |
| D5751 |
|
86 |
86 |
$10K |
| D1999 |
|
694 |
529 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
532 |
$7K |
| D1110 |
Prophylaxis - adult |
104 |
103 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,715 |
307 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
71 |
$3K |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$1K |
| D0274 |
Bitewings - four radiographic images |
16 |
15 |
$230.31 |