| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,023 |
219 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
405 |
403 |
$17K |
| D4355 |
|
231 |
229 |
$16K |
| D1110 |
Prophylaxis - adult |
423 |
417 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
552 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
400 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
590 |
584 |
$7K |
| D0274 |
Bitewings - four radiographic images |
364 |
362 |
$6K |
| D5110 |
|
12 |
12 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
306 |
304 |
$4K |
| D2161 |
|
55 |
27 |
$3K |
| D1120 |
Prophylaxis - child |
126 |
126 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
282 |
277 |
$2K |
| D2160 |
|
37 |
16 |
$2K |
| D2394 |
|
25 |
12 |
$2K |
| D2335 |
|
26 |
12 |
$2K |
| D0160 |
|
12 |
12 |
$538.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
25 |
$204.23 |