| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,179 |
3,165 |
$176K |
| D1110 |
Prophylaxis - adult |
1,887 |
1,876 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,491 |
1,490 |
$95K |
| D1120 |
Prophylaxis - child |
2,346 |
2,340 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,256 |
4,238 |
$60K |
| D9430 |
|
1,478 |
1,329 |
$47K |
| D0330 |
Panoramic radiographic image |
1,527 |
1,525 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
845 |
844 |
$39K |
| D1351 |
Sealant - per tooth |
932 |
185 |
$25K |
| D4341 |
|
230 |
87 |
$16K |
| D4910 |
|
207 |
207 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,599 |
480 |
$10K |
| D0274 |
Bitewings - four radiographic images |
446 |
444 |
$8K |
| D1320 |
|
316 |
316 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
312 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
13 |
$1K |
| D0350 |
|
246 |
107 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
317 |
308 |
$0.00 |