| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D6010 |
|
223 |
72 |
$228K |
| D6058 |
|
107 |
39 |
$92K |
| D2750 |
|
114 |
94 |
$71K |
| D6056 |
|
109 |
37 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
323 |
200 |
$22K |
| D1110 |
Prophylaxis - adult |
434 |
429 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
426 |
416 |
$16K |
| D2954 |
|
61 |
55 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
683 |
652 |
$9K |
| D9110 |
|
234 |
225 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
362 |
358 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
192 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
25 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
28 |
$4K |
| D2332 |
|
32 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$3K |
| D2952 |
|
13 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
54 |
$828.00 |
| D1999 |
|
13 |
12 |
$0.00 |