| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4355 |
|
1,924 |
1,915 |
$235K |
| D4341 |
|
1,433 |
615 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
5,356 |
5,272 |
$142K |
| D1110 |
Prophylaxis - adult |
2,178 |
2,168 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,751 |
2,674 |
$102K |
| D5110 |
|
105 |
104 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
683 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,982 |
3,948 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,495 |
1,441 |
$45K |
| D5120 |
|
26 |
26 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
82 |
$17K |
| D4342 |
|
140 |
82 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
106 |
12 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
63 |
$1K |
| D1330 |
|
251 |
251 |
$0.00 |
| D9995 |
|
416 |
411 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
24 |
$0.00 |
| D9410 |
|
2,329 |
2,169 |
$0.00 |
| D9996 |
|
624 |
614 |
$0.00 |