| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
943 |
939 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
663 |
517 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,463 |
1,449 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
239 |
$18K |
| D0274 |
Bitewings - four radiographic images |
761 |
754 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
272 |
270 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
939 |
913 |
$11K |
| D2140 |
|
107 |
66 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,070 |
1,055 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
26 |
$2K |
| D3120 |
|
56 |
40 |
$0.00 |