| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,006 |
1,909 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,632 |
2,510 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
680 |
271 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,293 |
1,232 |
$34K |
| D0274 |
Bitewings - four radiographic images |
945 |
894 |
$27K |
| D5110 |
|
54 |
51 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
371 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,135 |
1,061 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
393 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
13 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
83 |
$5K |
| D5120 |
|
12 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
39 |
37 |
$2K |
| D2161 |
|
47 |
39 |
$2K |
| D2140 |
|
42 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
47 |
$80.00 |