| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,164 |
5,148 |
$340K |
| D1110 |
Prophylaxis - adult |
1,709 |
1,708 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
1,478 |
1,467 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,419 |
2,416 |
$116K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
972 |
523 |
$114K |
| D5750 |
|
295 |
295 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,462 |
2,839 |
$47K |
| D0330 |
Panoramic radiographic image |
1,529 |
1,521 |
$46K |
| D4910 |
|
563 |
559 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,414 |
2,409 |
$40K |
| D1320 |
|
2,032 |
2,030 |
$35K |
| D5751 |
|
141 |
141 |
$28K |
| D5520 |
|
463 |
82 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,795 |
1,620 |
$21K |
| D9430 |
|
622 |
584 |
$20K |
| D4341 |
|
141 |
42 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
45 |
$7K |
| D0274 |
Bitewings - four radiographic images |
266 |
266 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
256 |
256 |
$3K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$1K |