| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,938 |
2,247 |
$92K |
| D1110 |
Prophylaxis - adult |
1,001 |
997 |
$83K |
| D4910 |
|
694 |
691 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
862 |
859 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,076 |
2,810 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
421 |
$25K |
| D0330 |
Panoramic radiographic image |
786 |
785 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,802 |
1,448 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,462 |
1,455 |
$19K |
| D0274 |
Bitewings - four radiographic images |
874 |
872 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
271 |
269 |
$12K |
| D4341 |
|
106 |
28 |
$7K |
| D0270 |
|
746 |
626 |
$4K |
| D0350 |
|
408 |
205 |
$4K |
| D1120 |
Prophylaxis - child |
41 |
41 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$861.00 |
| D1330 |
|
13 |
13 |
$0.00 |