| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
3,727 |
3,096 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
777 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
993 |
976 |
$25K |
| D1110 |
Prophylaxis - adult |
776 |
665 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
146 |
$10K |
| D0250 |
|
310 |
296 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
41 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
87 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
265 |
115 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
135 |
$2K |
| D1354 |
|
157 |
56 |
$946.00 |
| D1120 |
Prophylaxis - child |
24 |
12 |
$341.52 |
| D1206 |
Topical application of fluoride varnish |
791 |
668 |
$285.26 |
| D0251 |
|
107 |
89 |
$0.00 |