| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
689 |
648 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
281 |
$6K |
| D2332 |
|
81 |
24 |
$5K |
| D1120 |
Prophylaxis - child |
112 |
112 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
114 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
89 |
88 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
264 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$422.50 |