| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,034 |
1,017 |
$76K |
| D1110 |
Prophylaxis - adult |
866 |
859 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
860 |
849 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,530 |
1,413 |
$35K |
| D4341 |
|
511 |
142 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
424 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,629 |
1,616 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
271 |
271 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,043 |
1,039 |
$12K |
| D1120 |
Prophylaxis - child |
160 |
157 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
269 |
$3K |
| D9110 |
|
31 |
29 |
$2K |
| D4342 |
|
50 |
13 |
$2K |