| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
471 |
227 |
$103K |
| D9110 |
|
1,581 |
1,486 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
475 |
214 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,356 |
1,276 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
494 |
491 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
613 |
598 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,760 |
1,655 |
$10K |
| D1120 |
Prophylaxis - child |
114 |
114 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
134 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
99 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
118 |
$3K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$239.28 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$150.40 |
| D1999 |
|
70 |
21 |
$0.00 |