| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,925 |
2,474 |
$432K |
| D5110 |
|
478 |
475 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,691 |
2,431 |
$108K |
| D0330 |
Panoramic radiographic image |
2,793 |
2,494 |
$81K |
| D5212 |
|
168 |
165 |
$71K |
| D5120 |
|
55 |
55 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
518 |
399 |
$20K |
| D1110 |
Prophylaxis - adult |
456 |
413 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,063 |
891 |
$13K |
| D0274 |
Bitewings - four radiographic images |
158 |
152 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
63 |
$2K |