| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
31,207 |
29,391 |
$3.05M |
| D0120 |
Periodic oral evaluation - established patient |
10,333 |
10,164 |
$237K |
| D1110 |
Prophylaxis - adult |
4,814 |
4,715 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,831 |
3,780 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,816 |
1,800 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
593 |
218 |
$57K |
| D5110 |
|
55 |
55 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
534 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,401 |
2,369 |
$29K |
| D5120 |
|
27 |
27 |
$21K |
| D1354 |
|
1,460 |
363 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
167 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
209 |
209 |
$2K |
| D0170 |
|
25 |
24 |
$781.53 |