| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,540 |
3,344 |
$300K |
| D9410 |
|
7,244 |
6,623 |
$201K |
| D9999 |
Unspecified adjunctive procedure, by report |
478 |
416 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,450 |
2,342 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
2,390 |
2,109 |
$109K |
| D9920 |
|
360 |
352 |
$49K |
| D5110 |
|
77 |
77 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,831 |
2,785 |
$41K |
| D5120 |
|
52 |
52 |
$32K |
| D4355 |
|
251 |
251 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
204 |
60 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
80 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
198 |
$3K |