| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
4,907 |
3,599 |
$465K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
859 |
859 |
$29K |
| D5110 |
|
40 |
39 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
426 |
421 |
$24K |
| D5120 |
|
27 |
26 |
$19K |
| D1110 |
Prophylaxis - adult |
204 |
204 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
956 |
475 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
531 |
521 |
$6K |
| D4341 |
|
42 |
12 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
280 |
280 |
$5K |
| D0274 |
Bitewings - four radiographic images |
151 |
150 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
107 |
$3K |
| D4346 |
|
13 |
13 |
$2K |