| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
792 |
273 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
363 |
214 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
64 |
59 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
294 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
536 |
$21K |
| D1110 |
Prophylaxis - adult |
450 |
439 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
414 |
$14K |
| D2160 |
|
113 |
81 |
$13K |
| D0274 |
Bitewings - four radiographic images |
449 |
438 |
$13K |
| D2332 |
|
81 |
41 |
$12K |
| D2950 |
|
95 |
85 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
386 |
377 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
587 |
555 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
17 |
$4K |
| D2140 |
|
40 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
132 |
$3K |