| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,198 |
2,180 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
1,899 |
1,887 |
$69K |
| D1110 |
Prophylaxis - adult |
770 |
769 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
759 |
$37K |
| D1120 |
Prophylaxis - child |
710 |
702 |
$31K |
| D4341 |
|
387 |
159 |
$23K |
| D4910 |
|
204 |
202 |
$12K |
| D0274 |
Bitewings - four radiographic images |
581 |
579 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,441 |
849 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
262 |
258 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
37 |
37 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
26 |
$4K |
| D1320 |
|
102 |
102 |
$2K |
| D9430 |
|
39 |
38 |
$992.00 |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
167 |
$928.10 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$531.50 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$135.00 |
| D1330 |
|
19 |
19 |
$0.00 |