| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
1,607 |
1,541 |
$153K |
| D1110 |
Prophylaxis - adult |
695 |
678 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
323 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
585 |
$13K |
| D0350 |
|
397 |
397 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
139 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
121 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
27 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
217 |
216 |
$2K |
| D1206 |
Topical application of fluoride varnish |
106 |
103 |
$2K |
| D5410 |
|
33 |
33 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
91 |
$1K |
| D5411 |
|
22 |
22 |
$889.68 |
| D1354 |
|
45 |
13 |
$248.85 |