| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
2,659 |
2,641 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
2,257 |
2,245 |
$135K |
| D4341 |
|
841 |
244 |
$55K |
| D1110 |
Prophylaxis - adult |
615 |
613 |
$52K |
| D1120 |
Prophylaxis - child |
1,178 |
1,169 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,709 |
2,696 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
285 |
283 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
213 |
$13K |
| D9110 |
|
111 |
107 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
449 |
308 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
400 |
389 |
$5K |
| D0272 |
Bitewings - two radiographic images |
282 |
276 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
24 |
$2K |
| D9430 |
|
54 |
49 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
12 |
$1K |