| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4381 |
|
3,408 |
330 |
$279K |
| D6010 |
|
157 |
76 |
$168K |
| D9920 |
|
1,250 |
1,249 |
$54K |
| D4910 |
|
694 |
686 |
$51K |
| D1110 |
Prophylaxis - adult |
793 |
778 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,067 |
1,045 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
912 |
894 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
736 |
723 |
$19K |
| D1330 |
|
1,273 |
1,272 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,164 |
1,130 |
$17K |
| D0274 |
Bitewings - four radiographic images |
206 |
206 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
175 |
$7K |
| D4341 |
|
48 |
14 |
$6K |
| D1206 |
Topical application of fluoride varnish |
100 |
100 |
$4K |