| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,984 |
1,776 |
$228K |
| D0140 |
Limited oral evaluation - problem focused |
2,200 |
1,968 |
$204K |
| D5110 |
|
190 |
152 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,235 |
1,140 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,176 |
$113K |
| D1110 |
Prophylaxis - adult |
1,219 |
1,154 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,097 |
639 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,128 |
2,799 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,709 |
4,194 |
$38K |
| D2140 |
|
849 |
512 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,750 |
1,621 |
$31K |
| D1351 |
Sealant - per tooth |
923 |
182 |
$28K |
| D2160 |
|
457 |
331 |
$23K |
| D2331 |
|
299 |
193 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
223 |
160 |
$10K |
| D2335 |
|
125 |
83 |
$9K |
| D1206 |
Topical application of fluoride varnish |
912 |
879 |
$8K |
| D5120 |
|
159 |
129 |
$8K |
| D4355 |
|
178 |
163 |
$8K |
| D2330 |
|
141 |
88 |
$5K |
| D2332 |
|
81 |
55 |
$5K |
| D1120 |
Prophylaxis - child |
279 |
267 |
$4K |
| D0190 |
|
216 |
214 |
$3K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$2K |
| D2161 |
|
17 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
79 |
$374.57 |