| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,642 |
1,630 |
$125K |
| D1110 |
Prophylaxis - adult |
1,140 |
1,130 |
$94K |
| D9410 |
|
2,625 |
1,707 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,120 |
1,113 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
959 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,959 |
1,949 |
$26K |
| D9110 |
|
240 |
231 |
$15K |
| D9430 |
|
432 |
425 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
963 |
524 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
230 |
$11K |
| D0274 |
Bitewings - four radiographic images |
254 |
250 |
$5K |
| D4341 |
|
53 |
15 |
$4K |
| D1320 |
|
361 |
359 |
$4K |
| D1120 |
Prophylaxis - child |
59 |
59 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$756.00 |
| D5411 |
|
22 |
15 |
$735.00 |
| D5410 |
|
20 |
14 |
$665.00 |
| D9920 |
|
12 |
12 |
$560.00 |