| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,460 |
1,755 |
$195K |
| D1110 |
Prophylaxis - adult |
4,730 |
4,721 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
2,398 |
2,391 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,619 |
1,596 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
816 |
605 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,752 |
1,747 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,573 |
2,517 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
651 |
648 |
$20K |
| D5110 |
|
45 |
45 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
642 |
640 |
$16K |
| D2140 |
|
457 |
300 |
$13K |
| D2752 |
|
20 |
13 |
$13K |
| D5120 |
|
25 |
25 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
903 |
533 |
$5K |
| D1206 |
Topical application of fluoride varnish |
188 |
188 |
$5K |
| D1120 |
Prophylaxis - child |
105 |
105 |
$4K |
| D2160 |
|
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$513.35 |