| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4260 |
|
436 |
120 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,964 |
2,946 |
$184K |
| D4341 |
|
2,582 |
670 |
$181K |
| D4910 |
|
2,344 |
2,335 |
$179K |
| D9430 |
|
4,734 |
4,056 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
2,020 |
2,011 |
$95K |
| D9951 |
|
934 |
237 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
320 |
320 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
161 |
104 |
$19K |
| D1110 |
Prophylaxis - adult |
159 |
159 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
29 |
$14K |
| D1206 |
Topical application of fluoride varnish |
597 |
595 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
470 |
459 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
284 |
$4K |
| D0330 |
Panoramic radiographic image |
52 |
49 |
$1K |
| D0274 |
Bitewings - four radiographic images |
54 |
54 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$199.00 |
| D9110 |
|
12 |
12 |
$0.00 |