| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
2,135 |
1,618 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
197 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
281 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
148 |
$2K |
| D1110 |
Prophylaxis - adult |
55 |
53 |
$2K |
| D0274 |
Bitewings - four radiographic images |
78 |
76 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
185 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
52 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$924.40 |