| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
775 |
767 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
759 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
745 |
$34K |
| D4910 |
|
327 |
324 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,037 |
2,289 |
$24K |
| D1110 |
Prophylaxis - adult |
325 |
324 |
$23K |
| D9430 |
|
690 |
668 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,710 |
1,619 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
985 |
973 |
$12K |
| D4341 |
|
194 |
59 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
15 |
$3K |
| D1120 |
Prophylaxis - child |
85 |
82 |
$3K |
| D0274 |
Bitewings - four radiographic images |
69 |
69 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |