| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
76 |
$22K |
| D1110 |
Prophylaxis - adult |
344 |
344 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
152 |
151 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
64 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
13 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
190 |
190 |
$5K |
| D2160 |
|
60 |
39 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
113 |
$4K |
| D0274 |
Bitewings - four radiographic images |
88 |
88 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
178 |
177 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
80 |
$3K |
| D4355 |
|
27 |
27 |
$2K |
| D2140 |
|
34 |
26 |
$1K |
| D2161 |
|
19 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
194 |
91 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$327.22 |