| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,940 |
3,231 |
$339K |
| D1110 |
Prophylaxis - adult |
5,986 |
5,742 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,563 |
3,458 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
2,170 |
1,774 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
5,026 |
4,836 |
$85K |
| D0274 |
Bitewings - four radiographic images |
5,166 |
4,921 |
$83K |
| D0330 |
Panoramic radiographic image |
2,473 |
2,387 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,015 |
806 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,456 |
3,340 |
$50K |
| D2140 |
|
1,124 |
787 |
$44K |
| D1120 |
Prophylaxis - child |
2,179 |
2,102 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,528 |
1,473 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
3,521 |
3,196 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
423 |
$10K |
| D5213 |
|
16 |
14 |
$9K |
| D5110 |
|
12 |
12 |
$5K |
| D0470 |
|
193 |
186 |
$4K |
| D7310 |
|
28 |
24 |
$3K |
| D2335 |
|
16 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
335 |
238 |
$1K |
| D2330 |
|
12 |
12 |
$613.68 |
| D1320 |
|
37 |
31 |
$555.00 |
| D1999 |
|
49 |
45 |
$0.00 |