| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,203 |
965 |
$140K |
| D1110 |
Prophylaxis - adult |
1,334 |
1,333 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,282 |
1,281 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
809 |
653 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
721 |
704 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,477 |
1,475 |
$31K |
| D2140 |
|
526 |
374 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
291 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,360 |
1,341 |
$16K |
| D2160 |
|
130 |
123 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,066 |
2,046 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
1,488 |
1,479 |
$7K |
| D5211 |
|
12 |
12 |
$4K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$2K |
| D1201 |
|
14 |
14 |
$0.00 |