| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
58,124 |
58,104 |
$4.91M |
| D9410 |
|
148,814 |
145,461 |
$4.14M |
| D4355 |
|
18,403 |
18,399 |
$1.88M |
| D0120 |
Periodic oral evaluation - established patient |
24,340 |
24,339 |
$1.40M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,218 |
21,216 |
$1.33M |
| D1208 |
Topical application of fluoride, excluding varnish |
58,060 |
58,049 |
$816K |
| D5410 |
|
4,574 |
4,569 |
$158K |
| D9920 |
|
801 |
795 |
$111K |
| D5411 |
|
2,666 |
2,663 |
$92K |
| D5850 |
|
926 |
926 |
$64K |
| D5851 |
|
495 |
495 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
36 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
166 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$720.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
26 |
$172.20 |