| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
24,423 |
23,816 |
$1.81M |
| D1110 |
Prophylaxis - adult |
10,950 |
10,734 |
$398K |
| D0120 |
Periodic oral evaluation - established patient |
13,626 |
13,382 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,006 |
3,920 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
1,597 |
1,573 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
953 |
438 |
$59K |
| D4355 |
|
479 |
469 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
69 |
$9K |
| D1206 |
Topical application of fluoride varnish |
4,120 |
4,058 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
14 |
$3K |
| D2335 |
|
20 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
53 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$560.16 |
| D0703 |
|
34 |
34 |
$0.00 |
| D0191 |
|
38 |
38 |
$0.00 |
| D9932 |
|
77 |
75 |
$0.00 |
| D0707 |
|
14 |
14 |
$0.00 |