| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,887 |
539 |
$83K |
| D1110 |
Prophylaxis - adult |
1,881 |
1,790 |
$60K |
| D5110 |
|
85 |
75 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,172 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,833 |
1,759 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,140 |
$24K |
| D2161 |
|
338 |
238 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,700 |
1,644 |
$23K |
| D0330 |
Panoramic radiographic image |
433 |
409 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,378 |
1,262 |
$12K |
| D5120 |
|
17 |
14 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
106 |
27 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
70 |
$6K |
| D1120 |
Prophylaxis - child |
229 |
229 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
258 |
$2K |
| D2160 |
|
37 |
27 |
$2K |
| D2335 |
|
20 |
12 |
$1K |
| D2140 |
|
33 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$358.26 |